Effect of HMG-Co-Reductase Inhibitor Use on 1-Year Mortality and Hospitalization Rates in Elderly Cardiovascular Disease Patients in Nursing Homes
Background:The risks and benefits of HMG-Co-Reductase Inhibitor therapy in elderly cardiovascular disease patients is not known. Aims: To compare the effects of statins on the 1-year mortality, and hospitalization rate in a cohort of elderly CVD patients. Methods: We conducted a historical cohort study using the SAGE database (1992-1997), a long-term care database linking patient clinical information with data on drug utilization, hospital discharges, and death. Among 51,599 newly admitted nursing home patients with CVD, we compared 1313 statin users to non-users matched by facility. The effects of statins on outcomes was estimated using a Cox proportional hazards model. Results: Prevalence of statin use in this CVD cohort was 2.5%. Statin use varied by age, gender, co-morbid condition,CHD risk factors, medication use, cognitive and physical function(p<.05). The number of deaths at one year was 265 in the statin users and 410 in the non-users. The 1-year all-cause mortality adjusted hazards ratio comparing statin users to non-users was HR=0.73, 95%CI (0.61-0.87). Number needed to treat(NNT)was 9. Results were similar for men and women, and for ages 65-74, 75-84, and 85 and older. Similar results were found for 1-year rates of hospitalization. Conclusion: HMG-Co-reductase inhibitor therapy appears to signficantly reduce 1-year all-cause mortality and hospitalization rates in a frail elderly population after adjusting for potential confounding.