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Poor short-term survival and low use of cardiovascular medications in elderly dialysis patients after acute myocardial infarction.
Am J Kidney Dis. 2006 Feb; 47(2):301-8.AJ

Abstract

BACKGROUND

Beta-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) are standard therapies after myocardial infarction (MI) in the general population. Their use and association with mortality in elderly dialysis patients after MI have not been studied sufficiently.

METHODS

Claims records from Medicare and Medicaid patients aged 65 years and older who participated in prescription benefit plans of 2 eastern states were used to identify dialysis patients with MI between 1995 and 2003. Study outcomes were outpatient use of beta-blockers, statins, and ACE inhibitors and/or ARBs within 90 days after MI. We used multivariate logistic regression to assess predictors of such use. Multivariate Cox regression was applied to test for associations between beta-blocker, statin, and ACE-inhibitor and/or ARB use and 1-year mortality.

RESULTS

We identified 902 dialysis patients who were hospitalized with MI. Of these, 39.5% died within 90 days and 63.6% died within 1 year after MI. Of 494 patients who were discharged within 21 days or less and survived longer than 90 days, 31.0% were administered an ACE inhibitor and/or ARB; 19.4%, a statin; and 34.2%, a beta-blocker after discharge. Use of ACE inhibitors and/or ARBs was associated with a 30% reduction in 1-year mortality (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.50 to 0.98), whereas statin (HR, 0.97; 95% CI, 0.65 to 1.45) and beta-blocker use (HR, 1.05; 95% CI, 0.78 to 1.43) were not.

CONCLUSION

Elderly dialysis patients have excessively high mortality and low use of standard therapies after MI. Only ACE inhibitors and/or ARBs were associated with a reduced risk for death at 1 year in this population. Whether the high mortality rate in this population is attributable to such low use of preventive cardiovascular medications remains uncertain.

Authors+Show Affiliations

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. wwinkelmayer@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16431259

Citation

Winkelmayer, Wolfgang C., et al. "Poor Short-term Survival and Low Use of Cardiovascular Medications in Elderly Dialysis Patients After Acute Myocardial Infarction." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 47, no. 2, 2006, pp. 301-8.
Winkelmayer WC, Charytan DM, Levin R, et al. Poor short-term survival and low use of cardiovascular medications in elderly dialysis patients after acute myocardial infarction. Am J Kidney Dis. 2006;47(2):301-8.
Winkelmayer, W. C., Charytan, D. M., Levin, R., & Avorn, J. (2006). Poor short-term survival and low use of cardiovascular medications in elderly dialysis patients after acute myocardial infarction. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 47(2), 301-8.
Winkelmayer WC, et al. Poor Short-term Survival and Low Use of Cardiovascular Medications in Elderly Dialysis Patients After Acute Myocardial Infarction. Am J Kidney Dis. 2006;47(2):301-8. PubMed PMID: 16431259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor short-term survival and low use of cardiovascular medications in elderly dialysis patients after acute myocardial infarction. AU - Winkelmayer,Wolfgang C, AU - Charytan,David M, AU - Levin,Raisa, AU - Avorn,Jerry, PY - 2005/08/15/received PY - 2005/10/10/accepted PY - 2006/1/25/pubmed PY - 2006/3/22/medline PY - 2006/1/25/entrez SP - 301 EP - 8 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 47 IS - 2 N2 - BACKGROUND: Beta-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) are standard therapies after myocardial infarction (MI) in the general population. Their use and association with mortality in elderly dialysis patients after MI have not been studied sufficiently. METHODS: Claims records from Medicare and Medicaid patients aged 65 years and older who participated in prescription benefit plans of 2 eastern states were used to identify dialysis patients with MI between 1995 and 2003. Study outcomes were outpatient use of beta-blockers, statins, and ACE inhibitors and/or ARBs within 90 days after MI. We used multivariate logistic regression to assess predictors of such use. Multivariate Cox regression was applied to test for associations between beta-blocker, statin, and ACE-inhibitor and/or ARB use and 1-year mortality. RESULTS: We identified 902 dialysis patients who were hospitalized with MI. Of these, 39.5% died within 90 days and 63.6% died within 1 year after MI. Of 494 patients who were discharged within 21 days or less and survived longer than 90 days, 31.0% were administered an ACE inhibitor and/or ARB; 19.4%, a statin; and 34.2%, a beta-blocker after discharge. Use of ACE inhibitors and/or ARBs was associated with a 30% reduction in 1-year mortality (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.50 to 0.98), whereas statin (HR, 0.97; 95% CI, 0.65 to 1.45) and beta-blocker use (HR, 1.05; 95% CI, 0.78 to 1.43) were not. CONCLUSION: Elderly dialysis patients have excessively high mortality and low use of standard therapies after MI. Only ACE inhibitors and/or ARBs were associated with a reduced risk for death at 1 year in this population. Whether the high mortality rate in this population is attributable to such low use of preventive cardiovascular medications remains uncertain. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16431259/Poor_short_term_survival_and_low_use_of_cardiovascular_medications_in_elderly_dialysis_patients_after_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01524-6 DB - PRIME DP - Unbound Medicine ER -