Survivors of myocardial infarction, AKI less likely prescribed some cardiovascular drugs
Click Here to Manage Email Alerts
Patients with a history of myocardial infarction are unlikely to receive prescriptions for angiotensin-converting enzyme/angiotensin receptor blockers, beta-blockers or statins if they are also survivors of AKI, according to findings.
“AKI complicates 15% of hospitalizations and more than 60% of ICU admissions. These patients are at higher risk of cardiovascular morbidity and mortality,” Alejandro Y. Meraz-Muñoz, MD, from the division of nephrology at the University of Toronto, Canada, said at ASN Kidney Week. “However, patients who survive an episode of AKI may receive fewer evidence-based cardiovascular medications, such as angiotensin-converting enzyme (ACEi)/ angiotensin receptor blockers (ARBs), beta-blockers and statins.”
In a population-based study of patients at least 66 years old with a history of myocardial infarction (MI) hospitalizations from Jan. 1, 2008, to March 31, 2017, researchers determined the use of cardiovascular drugs following AKI.
Using Kidney Disease: Improving Global Outcomes serum creatinine criteria, researchers ascertained AKI, and assembled a cohort of patients with and those without AKI using propensity score matching.
While accounting for the competing risk of death, researchers used proportional subdistribution hazards regression to evaluate the cumulative incidence of receipt of cardiovascular drugs after AKI compared with patients without AKI.
“Our main outcome was the time to outpatient dispensing of ACEi/ARB, statin or beta-blocker within 1 year of hospital discharge,” Meraz-Muñoz said. “Secondary outcomes were times to outpatient dispensing of other cardiovascular drugs.”
Among the 28,871 patients with AKI, 21,452 were matched 1:1 to patients with similar characteristics and without AKI. Patients with AKI were 7% less likely to receive all three cardiovascular drug classes within 1 year of hospital discharge. Similarly, patients with any degree of AKI were 13% less likely to receive ACEi/ARB prescriptions.
However, AKI correlated with a higher use of loop diuretics and mineralocorticoid receptor antagonists.
“In conclusion, in patients with a history of MI, survivors of AKI were less likely to receive ACEi/ARB, statins or beta-blockers at 1 year after discharge,” Meraz-Muñoz said. “This association was most pronounced in patients with stage 2 and 3 AKI, and these results highlight a gap in these patients’ care that needs to be addressed in order to ensure safe, timely and persistent therapy in patients with indications for cardioprotective drugs after AKI.”
Collapse
Meraz-Munoz AY, et al. Paper TH-OR07. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
Click Here to Manage Email Alerts