Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents

Comparative Effectiveness of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in Older Nursing Home Residents After Myocardial Infarction: A Retrospective Cohort Study

“…This was a retrospective new-user cohort study using existing (18)(19)(20)(21)(22)(23)(24) national Medicare data linked to the Minimum Data Set (MDS) version 2.0 and Online Survey Certification and Reporting System (OSCAR) data. The MDS is a comprehensive, clinical assessment instrument used to document health status of NH residents, including demographic, medical, functional status, psychological, and cognitive status information.…”

“…The study population was a previously established (18)(19)(20)(21)(22)(23)(24) national cohort of long-stay NH residents aged ≥65 years who were hospitalized for AMI (ICD-9 codes 410.XX or 411.1 in principal or secondary position on inpatient claim), had not taken an ARB or ACEI for at least 12 months before the AMI, and were readmitted to a U.S. NH directly after hospital discharge between May 1, 2007 and December 31, 2010 (eFigure 1). We excluded patients with extremely poor functional status before the AMI hospitalization (ADL score ≥24) because they had little opportunity for further functional decline (see Outcomes below) (18).…”

“…Previous non-users were selected to evaluate the decision to initiate either ARBs or ACEIs after AMI, distinct from the decision to continue these agents in patients who had already been taking them before their AMI. Additional details of the cohort have been previously described (18)(19)(20)(21)(22)(23)(24).…”

“…ARB or ACEI initiation after AMI was identified in Medicare Part D prescription drug claims (individual drugs listed in eTable 1) (18)(19)(20)(21)(22)(23)(24). The causal contrast of interest was defined as the effect of initiating ARBs versus ACEIs, regardless of subsequent treatment discontinuation or switching among treatment groups.…”

“…However, it is unlikely that this issue would have differentially affected ARB or ACEI users. Other limitations of the datasets and study cohort have been previously discussed (18)(19)(20)(21)(22)(23)(24).…”