In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents With Heart Failure

Wilbert S. Aronow, Michael W. Rich, Sarah J. Goodlin, Thomas Birkner, Yan Zhang, Margaret A. Feller, Inmaculada B. Aban, Linda G. Jones, Donna M. Bearden, Richard M. Allman, Ali Ahmed

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objectives: To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF). Participants: Hospitalized NH residents (n = 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998-2001. Design: Observational. Measurements of Evidence-Based Care: Preadmission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n = 494), in-hospital LVEF estimation for HF patients without known LVEF (n = 452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) to systolic HF (LVEF <45%) patients discharged alive who were eligible to receive those drugs (n = 83). Eligibility for ACEIs or ARBs was defined as lack of prior allergy or adverse effect, serum creatinine lower than 2.5 mg/dL, serum potassium lower than 5.5 mEq/L, and systolic blood pressure higher than 100 mm Hg. Results: Preadmission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio [AOR], 3.49; 95% CI, 2.16-5.66; P < .001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69-9.79; P < .001). ACEIs or ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07-0.81; P = .022). Conclusion: In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF; however, it did not translate into higher odds of discharge prescriptions for ACEIs or ARBs to NH residents with systolic HF who were eligible for the receipt of these drugs.

Original languageEnglish (US)
Pages (from-to)448-452
Number of pages5
JournalJournal of the American Medical Directors Association
Volume13
Issue number5
DOIs
StatePublished - Jun 2012

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Keywords

  • Cardiology consultation
  • Evidence-based care
  • Heart failure
  • Nursing home residents

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Aronow, W. S., Rich, M. W., Goodlin, S. J., Birkner, T., Zhang, Y., Feller, M. A., Aban, I. B., Jones, L. G., Bearden, D. M., Allman, R. M., & Ahmed, A. (2012). In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents With Heart Failure. Journal of the American Medical Directors Association, 13(5), 448-452. https://doi.org/10.1016/j.jamda.2011.09.001