OBJECTIVES: Anticoagulant (AC) for stroke prevention in nursing home (NH) residents with atrial fibrillation (AF) involves a challenging risk-benefit evaluation. We examine facility characteristics associated with continuing AC users.

METHODS: This is a retrospective cohort analysis based on 2015 Minimum Data Set (MDS), merged with Nursing Home Compare data files. Facility characteristics include proportion of continuing AC users, occupancy, size, ownership, staffing, and proportion of residents with Medicare or Medicaid payment. Individual characteristics include demographics (age, gender, race/ethnicity), clinical (CAD, COPD, arthritis, cancer, cirrhosis, anemia, renal insufficiency, bleeding) and functional status (fall history, ADL scores, cognitive impairment, mobility impairment, and weight loss). Logistic regression with random effects were conducted.

RESULTS: There were 48,545 NH residents with AF whose CHA₂DS₂-VASc scores being at least 2 and who had AC for at least two months. Residents in NHs with the highest facility-level AC rates were 1.55 times more likely to continuously use AC compared to those in low rate NHs, after adjusting for individual indications (Odds Ration [OR]=1.55; 95% confidence interval [CI], 1.14-2.12). Residents in for-profit organizations (OR=0.80; 95% CI: 0.74-0.87) and in high proportion of Medicaid residents (OR: 0.92; 95% CI: 0.81-0.94) were less likely to be continuous AC user, while higher staffing, particularly high CNA time (OR: 1.26; 95% CI: 1.18-1.34) with patients, was positively associated with possibility of AF residents to use AC continuously. Overall, facility characteristics contributed to 30%, while residents’ characteristics contributed to 55%, of variations in continuous AC users in NHs.

CONCLUSIONS: NH facility can explain some proportion of continuous use of AC in NHs, along with individual characteristics. However, unexplained factors continue to exist to explain continuous AC uses. Future research is needed to identify those unexplained factors and determine why such a prescribing culture exists and whether it could result in adverse health consequences.