Acute Myocardial Infarction in Nursing Home Residents: Adherence to Treatment Guidelines Reduces Mortality, But Why Is Adherence So Low?

2009 ◽  
Vol 10 (1) ◽  
pp. 56-61 ◽  
Author(s):  
C LEVY ◽  
T RADCLIFF ◽  
E WILLIAMS ◽  
E HUTT
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nursing Home ◽  
Treatment Guidelines ◽  
Nursing Home Residents ◽  
Adherence To Treatment

scholarly journals Association of β-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction

2017 ◽  
Vol 177 (2) ◽  
pp. 254 ◽  
Author(s):  
Michael A. Steinman ◽  
Andrew R. Zullo ◽  
Yoojin Lee ◽  
Lori A. Daiello ◽  
W. John Boscardin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nursing Home ◽  
Functional Outcomes ◽  
Nursing Home Residents ◽  
Β Blockers

scholarly journals Outcomes of “diabetes-friendly” vs “diabetes-unfriendly” β-blockers in older nursing home residents with diabetes after acute myocardial infarction

2018 ◽  
Vol 20 (12) ◽  
pp. 2724-2732 ◽  
Author(s):  
Andrew R. Zullo ◽  
Michelle Hersey ◽  
Yoojin Lee ◽  
Sadia Sharmin ◽  
Elliott Bosco ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Β Blockers

Increasing the Penetration of Primary Angioplasty in Europe

2012 ◽  
Vol 8 (1) ◽  
pp. 60 ◽  
Author(s):  
Zuzana Kaifoszova ◽  
Petr Widimsky ◽  
◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Treatment Guidelines ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Success Factor ◽  
The Balkans ◽  
Life Saving ◽  
Percutaneous Coronary

Primary percutaneous coronary intervention (PPCI) is recommended by the European Society of Cardiology (ESC) treatment guidelines as the preferred treatment for ST-elevation acute myocardial infarction (STEMI) whenever it is available within 90–120 minutes of the first medical contact. A survey conducted in 2008 in 51 ESC countries found that the annual incidence of hospital admissions for acute myocardial infarction is around 1,900 patients per million population, with an incidence of STEMI of about 800 per million. It showed that STEMI patients’ access to reperfusion therapy and the use of PPCI or thrombolysis (TL) vary considerably between countries. Northern, western and central Europe already have well-developed PPCI services, offering PPCI to 60–90 % of all STEMI patients. Southern Europe and the Balkans are still predominantly using TL. Where this is the case, a higher proportion of patients are left without any reperfusion treatment. The survey concluded that a nationwide PPCI strategy results in more patients being offered reperfusion therapy. To address the inequalities in STEMI patients’ access to life-saving PPCI, and to support the implementation of the ESC STEMI treatment guidelines in Europe, the Stent for Life (SFL) Initiative was launched jointly by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and EuroPCR in 2008. National cardiac societies from Bulgaria, France, Greece, Serbia, Spain and Turkey signed the SFL Declaration at the ESC Congress in Barcelona in 2009. The aim of the SFL Initiative is to improve the delivery of, and STEMI patients’ access to, life-saving PPCI and thereby reduce mortality and morbidity. Currently, 10 national cardiac societies support the SFL Initiative in their respective countries. SFL national action programmes have been developed and are being implemented in several countries. The formation of regional PPCI networks involving emergency medical services, non-percutaneous coronary intervention hospitals and PPCI centres is considered to be a critical success factor in implementing PPCI services effectively. This article describes examples of how SFL countries are progressing in implementing their national programmes, thus increasing PPCI penetration in Europe.

Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents

2021 ◽  
pp. 106002802110592
Author(s):  
Barbara Blaylock ◽  
Xiaoli Niu ◽  
H. Edward Davidson ◽  
Stefan Gravenstein ◽  
Ronald DePue ◽  
...  
Keyword(s):  
Nursing Home ◽  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Chronic Obstructive ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Treatment Pathways ◽  
Selection Of Variables ◽  
Long Acting

Background Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. Objective The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. Methods A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider–completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. Results Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). Conclusion and Relevance The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.

scholarly journals Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study

2016 ◽  
Vol 65 (4) ◽  
pp. 754-762 ◽  
Author(s):  
Andrew R. Zullo ◽  
Yoojin Lee ◽  
Lori A. Daiello ◽  
Vincent Mor ◽  
W. John Boscardin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Nursing Home ◽  
Beta Blocker ◽  
Nursing Home Residents ◽  
National Study

scholarly journals Secondary Prevention Medication Use After Myocardial Infarction in U.S. Nursing Home Residents

2017 ◽  
Vol 65 (11) ◽  
pp. 2397-2404 ◽  
Author(s):  
Andrew R. Zullo ◽  
Sadia Sharmin ◽  
Yoojin Lee ◽  
Lori A. Daiello ◽  
Nishant R. Shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Nursing Home ◽  
Secondary Prevention ◽  
Medication Use ◽  
Nursing Home Residents

scholarly journals Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s127-s128
Author(s):  
Taniece R. Eure ◽  
Nicola D. Thompson ◽  
Austin Penna ◽  
Wendy M. Bamberg ◽  
Grant Barney ◽  
...  
Keyword(s):  
Nursing Home ◽  
Urinary Tract ◽  
Nursing Homes ◽  
Treatment Guidelines ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Emerging Infections ◽  
Tract Infections ◽  
Uncomplicated Cystitis

Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich & Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.Funding: NoneDisclosures: None

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