Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay

J Card Fail. 2017 Dec;23(12):843-851. doi: 10.1016/j.cardfail.2017.09.007. Epub 2017 Sep 20.


Background: Little is known about guideline-directed pharmacotherapy use in patients with heart failure and reduced ejection fraction (HFrEF) discharged to skilled nursing facilities (SNFs). This study aimed to describe the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and evidence-based β-blockers (EBBBs) among older patients with HFrEF within 90 days after the SNF admission and to identify factors associated with receipt of these medications.

Methods and results: With the use of Minimum Data Set 3.0 cross-linked with Medicare data (2011-2012), we studied 35,792 Americans aged ≥65 years with HFrEF admitted to 10,333 SNFs. The median age was 82 years, 59% were women, 81% had at least moderate physical limitations, and 39% had moderate/severe cognitive impairment. Fifty-six percent received an ACEI/ARB and 53% an EBBB; one-fourth received neither. In a multivariable log-binomial model, advanced age, severe physical limitations, and greater number of comorbid conditions not associated with heart failure were inversely associated with ACEI/ARB and EBBB receipt.

Conclusions: Use of standard pharmacotherapy among patients with HFrEF after an SNF stay is higher than previously reported. In the absence of evidence demonstrating the effectiveness of ACEIs/ARBs and EBBBs in this population, whether or not improvements in prescribing are warranted remains unknown.

Keywords: Heart failure with reduced ejection fraction; angiotensin-converting enzyme inhibitors; skilled nursing facility; β-blockers.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Cross-Sectional Studies
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Medicare / trends
  • Skilled Nursing Facilities / statistics & numerical data
  • Skilled Nursing Facilities / trends*
  • Stroke Volume / physiology*
  • United States / epidemiology


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors