OBJECTIVES Studies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. We evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents. DESIGN We conducted a retrospective cohort study using 2007-2010 linked national data from Minimum Data Set (MDS) assessments, Medicare claims, and Online Survey Certification and Reporting System records. SETTING AND PARTICIPANTS We included US NH residents 65 years and older who were statin nonusers, were hospitalized for AMI between May 2007 and March 2010, and returned to the NH. MEASURES Outcomes were functional decline, death, and rehospitalization in the first year after post-AMI NH admission. New statin users were 1:1 propensity-score matched to nonusers to adjust for 92 characteristics. We estimated hazard ratios (HRs) and restricted mean survival time differences with 95% confidence intervals (CIs) comparing individuals who did vs did not initiate statin therapy after AMI hospitalization. RESULTS Propensity-score matching yielded a cohort of 5440 residents. Mean age was 83 years and 69% were female. Statin use was associated with a reduction in mortality (HR 0.80, 95% CI 0.73-0.87), corresponding to a mean of 15.9 (95% CI 9.9-22.0) days of extended life expectancy. No overall differences in rehospitalization (HR 1.06, 95% CI 0.98-1.14) or functional decline (HR 1.00, 95% CI 0.88-1.14) were observed. CONCLUSIONS AND IMPLICATIONS Statins may reduce 1-year mortality by 20% without affecting function among older NH residents who wish to live longer after AMI. During shared decision making with these patients or their representatives, clinicians should consider communicating that the average benefit of statins is 16 days of additional survival over 1 year.

中文翻译：

---

用于二级预防的他汀类药物对疗养院居民的功能和其他结果的影响

目标 研究他汀类药物对急性心肌梗死 (AMI) 后的影响，排除了虚弱的老年人，尤其是疗养院 (NH) 居民，并且很少检查功能结果。年长的新罕布什尔州居民可能从他汀类药物中获益较少，并且特别容易受到药物不良事件的影响，例如与肌病相关的功能下降。我们评估了他汀类药物对 NH 居民 1 年功能衰退、再住院和死亡的影响。设计 我们使用 2007-2010 年链接的国家数据进行了一项回顾性队列研究，这些数据来自最小数据集 (MDS) 评估、医疗保险索赔以及在线调查认证和报告系统记录。地点和参与者 我们纳入了 65 岁及以上未服用他汀类药物的美国 NH 居民，他们在 2007 年 5 月至 2010 年 3 月期间因 AMI 住院，并返回 NH。测量 结果是 AMI 后 NH 入院后第一年的功能衰退、死亡和再住院。新的他汀类药物使用者与非使用者进行 1:1 倾向评分匹配，以针对 92 项特征进行调整。我们估计了风险比 (HR) 和受限的平均生存时间差异以及 95% 置信区间 (CI)，比较在 AMI 住院后开始他汀类药物治疗和未开始他汀类药物治疗的个体。结果 倾向得分匹配产生了 5440 名居民的队列。平均年龄为 83 岁，69% 为女性。他汀类药物的使用与死亡率降低相关（HR 0.80，95% CI 0.73-0.87），相当于平均延长预期寿命 15.9（95% CI 9.9-22.0）天。未观察到再住院（HR 1.06，95% CI 0.98-1.14）或功能下降（HR 1.00，95% CI 0.88-1.14）方面的总体差异。结论和意义 他汀类药物可将 1 年死亡率降低 20%，而不会影响希望在 AMI 后活得更久的老年 NH 居民的功能。在与这些患者或其代表共同做出决策时，临床医生应考虑传达他汀类药物的平均益处是在 1 年内额外存活 16 天。