Comparative Effectiveness of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in Older Nurs
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ORIGINAL RESEARCH ARTICLE
Comparative Effectiveness of Angiotensin II Receptor Blockers and Angiotensin‑Converting Enzyme Inhibitors in Older Nursing Home Residents After Myocardial Infarction: A Retrospective Cohort Study Andrew R. Zullo1,2,3 · Melissa R. Riester3 · Sebhat Erqou4 · Wen‑Chih Wu1,2,4 · James L. Rudolph1,2,5 · Michael A. Steinman6
© This is a U.S. government work and its text is not subject to copyright protection in the United States ; however, its text may be subject to foreign copyright protection 2020
Abstract Background Evidence regarding differences in outcomes between angiotensin II receptor blockers (ARBs) and angiotensinconverting enzyme inhibitors (ACEIs) among older nursing home (NH) residents after acute myocardial infarction (AMI) is limited. Objectives The purpose of our study was to estimate the post-AMI effects of ARBs versus ACEIs on mortality, rehospitalization, and functional decline outcomes in this important population. Methods This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population included individuals aged ≥ 65 years who resided in a US NH ≥ 30 days, were hospitalized for AMI between May 2007 and March 2010, and returned to the NH. We compared 90-day mortality, rehospitalization, and functional decline outcomes between ARB and ACEI users with inverse-probability-of-treatment-weighted binomial and multinomial logistic regression models. Results Of the 2765 NH residents, 270 (9.8%) used ARBs and 2495 (90.2%) used ACEIs. The mean age of ARB versus ACEI users was 82.3 versus 82.7 years, respectively. No marked differences existed between ARB and ACEI users for mortality [odds ratio (OR) 1.18; 95% confidence interval (CI) 0.78–1.79], rehospitalization (OR 1.22; 95% CI 0.90–1.65), or functional decline (OR 1.23; 95% CI 0.88–1.74). In subgroup analyses, ARBs were associated with increased mortality and rehospitalization in individuals with moderate to severe cognitive impairment and with increased rehospitalization in those aged
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