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Geriatrics research shaping the future of care: from ARNI exposure to pharmacist-led deprescribing and EHR–Medicare validation
Researchers presenting at the American Geriatrics Society (AGS) Virtual Annual Scientific Meeting (#AGS26), taking place April 30th – May 2nd (pre-conference days Monday, April 27th – Wednesday, April 29th), represent the leading voices in geriatrics scholarship. Selected from a highly competitive pool of 746 submissions, this year’s Plenary Paper Presenters will showcase innovative research aimed at advancing the health and well-being of older adults. The #AGS26 Plenary Paper Session (Thursday, April 30th, 11:15–12:00 PM EST) will feature distinguished speakers that will highlight the wide-ranging impact of geriatrics research, demonstrating its critical role in shaping the future of caring for all of us as we age.
Sacubitril/Valsartan Use across Transitions between Community, Hospital, and Skilled Nursing Facility Settings (presented by Andrew R. Zullo, PharmD, PhD)
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that improves outcomes in heart failure. However, its use in hospital and ambulatory settings remain low and its use in post-hospitalization skilled nursing facility settings is not well characterized. Dr. Zullo and his colleagues conducted a retrospective parallel cohort study to describe ARNI use among older adults who transferred to skilled nursing facilities after being hospitalized for heart failure. The study assessed ARNI exposure of about 207,695 older adults who were discharged to skilled nursing facilities in the Long-Term Care Data Cooperative or the Veterans Health Administration from 1 year before hospitalization through 100 days after admission. Dr. Zullo and colleagues found that 5.4% of the Long-Term Care Data Cooperative patients and 8% of VA patients were exposed to ARNI. Among those exposed to ARNI before their admission, less than half of both the Long-Term Care Data Cooperative and VA patient populations received ARNI during their stay in a skilled nursing facility setting. Dr. Zullo and his colleagues concluded that ARNI use is infrequent among older adults discharged to skilled nursing facilities after hospitalization for heart failure, and discontinuation is common.
Effectiveness of Pharmacist-Led Telemedicine Deprescribing vs. Usual Care for Older Adults with Cognitive Impairment: A Pragmatic Randomized Clinical Trial (presented by Ariel R. Green, MD, PhD, MPH)
Dr. Green and colleagues conducted this study to evaluate the effectiveness of ALIGN, a pragmatic pharmacist-led deprescribing intervention for older adults with cognitive impairment in primary care. The intervention included: 1) a deprescribing brochure for patients/caregivers, 2) a telehealth visit with a clinic pharmacist; and 3) pharmacist-PCP communication with tailored recommendations. The study enrolled adults age 65 and older with mild cognitive impairment or dementia who were taking five or more medications. Participants were recruited from 21 community-based primary care clinics across Maryland between May 2024 and October 2025. Clinics were cluster-randomized to either implement the intervention or serve as a waitlist control. Dr. Green and colleagues found that ALIGN did not significantly reduce overall or potentially inappropriate medication prescribing in people with cognitive impairment. However, the between-group differences were clinically meaningful, indicating effectiveness when implemented as intended.
Measuring Hospitalization, Deaths, and Hospice Care from Skilled Nursing Facility Electronic Health Records vs. Medicare Claims (presented by Christopher M. Santostefano, MPH, RN)
In this study, Mr. Santostefano and colleagues aimed to validate measures of hospitalization, death, and hospice care between skilled nursing facility EHR data and Medicare claims. Using the Long-Term Care (LTC) Data Cooperative dataset, Medicare claims, and encounter records, Mr. Santostefano and colleagues were able to match available EHR documentation at the person-level to concurrent Medicare claims for a specific outcome (hospitalizations, date of death, and hospice care). Mr. Santostefano and his colleagues found that almost 93% of EHR-identified hospital stays matched to an inpatient, emergency department, or observation claims, with comparable match rates among Medicare and Medicare Advantage enrollees. Mr. Santostefano and his colleagues observed high levels of alignment between the LTC Data Cooperative skilled nursing facility EHR data and person-matched Medicare claims for hospitalizations and deaths. However, hospice care was more often missing from the EHR documentation than the other two outcome specific cohorts.
