One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

被引：12
|
作者：
Campitelli, Michael A. [1 ]
Maxwell, Colleen J. [1 ,11 ,12 ]
Maclagan, Laura C. [1 ]
Ko, Dennis T. [1 ,2 ,3 ,5 ,6 ]
Bell, Chaim M. [1 ,5 ,8 ]
Jeffs, Lianne [6 ,7 ,10 ]
Morris, Andrew M. [5 ]
Lapane, Kate L. [13 ]
Daneman, Nick [1 ,2 ,4 ,5 ,6 ]
Bronskill, Susan E. [1 ,2 ,6 ,9 ]
机构：
[1] Sunnybrook Hlth Sci Ctr, ICES, Toronto, ON, Canada
[2] Sunnybrook Hlth Sci Ctr, Sunnybrook Res Inst, Toronto, ON, Canada
[3] Sunnybrook Hlth Sci Ctr, Dept Cardiol, Toronto, ON, Canada
[4] Sunnybrook Hlth Sci Ctr, Div Infect Dis, Toronto, ON, Canada
[5] Univ Toronto, Dept Med, Toronto, ON, Canada
[6] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[7] Univ Toronto, Lawrence S Bloomberg Fac Nursing, Toronto, ON, Canada
[8] Mt Sinai Hlth Syst, Div Gen Internal Med, New York, NY USA
[9] Womens Coll Hosp, Womens Coll Res Inst, Toronto, ON, Canada
[10] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
[11] Univ Waterloo, Sch Pharm, Waterloo, ON, Canada
[12] Univ Waterloo, Sch Publ Hlth & Hlth Syst, Waterloo, ON, Canada
[13] Univ Massachusetts, Dept Quantitat Hlth Sci, Med Sch, Worcester, MA USA
来源：
CANADIAN MEDICAL ASSOCIATION JOURNAL | 2019年 / 191卷 / 02期
基金：
加拿大健康研究院;
关键词：
NURSING-HOME RESIDENTS; MEDICATION USE; HEART-DISEASE; THERAPY; PREVALENCE; MORTALITY; STATEMENT; FRAILTY;
D O I：
10.1503/cmaj.180853
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
BACKGROUND: Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting. METHODS: We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively. RESULTS: Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins. INTERPRETATION: The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.
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页码：E32 / E39
页数：8
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