Antiischemic therapy in patients with coronary heart disease living in long-term care

We evaluated antiischemic therapy in elderly nursing home residents with a diagnosis of coronary heart disease (CHD) using a population-based data bas e with over 300,000 residents (1992-1995) of all Medicare/Medicaid-certifie d nursing homes of five states. We identified 72,263 patients age 65 years or older with a diagnosis of CHD. We examined data collected with the feder ally mandated Minimum Data Set, drug information, and Medicare hospital cla ims. Antiischemics were defined as beta-adrenergic blockers, long-term nitr ates, and calcium channel blockers. We determined factors associated with u se of the drugs by logistic regression. Antiischemic therapy was inversely related to age and cognitive and physical functioning, but positively assoc iated with recent hospitalization and concomitant cardiovascular diseases. beta-Adrenergic blockers were least likely to be administered regardless of age, gender, or cognitive or physical function. We conclude that antiische mic therapy in nursing home residents may not be optimal.