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Use of beta-blockers and aspirin after myocardial infarction by patient renal function in the Department of Defense health care system.
Am J Kidney Dis. 2006 Apr; 47(4):593-603.AJ

Abstract

BACKGROUND

Whether the previously reported underutilization of standard-of-care medications in the management of patients with acute myocardial infarction (AMI) persists in more recent years or differs by ward of admission has not been reported.

METHODS

We performed a retrospective cross-sectional study of patients hospitalized with a discharge diagnosis of incident AMI to a Department of Defense hospital (Walter Reed Army Medical Center, Washington, DC) from 2001 through 2004. Use of beta-blockers and aspirin at the time of discharge after AMI was assessed according to Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rate (eGFR) in milliliters per minute per 1.73 m2, stratified by admission to the coronary care unit (CCU) versus other wards. Adjusted odds ratios for discharge beta-blocker and aspirin therapy were calculated by using logistic regression.

RESULTS

Among 431 patients, overall discharge use of beta-blockers was 86.8%, and aspirin, 86.8%, both significantly greater after CCU admission than admission to other wards (93%, aspirin use; 91.7%, beta-blocker use; P < 0.001 and P < 0.001). In logistic regression, CCU admission was the only independent factor associated with either beta-blocker or aspirin use; MDRD eGFR was not associated significantly with beta-blocker and aspirin use regardless of admission to the CCU or non-CCU.

CONCLUSION

Future studies of disparities in use of standard-of-care medications after AMI according to renal function should account for the primary site of admission, particularly CCU versus others. In addition, legitimate contraindications to the use of beta-blockers and aspirin may be subtle, including appropriate end-of-life decisions.

Authors+Show Affiliations

Nephrology Service, Clinical Information System, Walter Reed Army Medical Center, Washington, DC 20307, USA. kevin.abbott@na.amedd.army.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16564937

Citation

Abbott, Kevin C., et al. "Use of Beta-blockers and Aspirin After Myocardial Infarction By Patient Renal Function in the Department of Defense Health Care System." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 47, no. 4, 2006, pp. 593-603.
Abbott KC, Bohen EM, Yuan CM, et al. Use of beta-blockers and aspirin after myocardial infarction by patient renal function in the Department of Defense health care system. Am J Kidney Dis. 2006;47(4):593-603.
Abbott, K. C., Bohen, E. M., Yuan, C. M., Yeo, F. E., Sawyers, E. S., Perkins, R. M., Lentine, K. L., Oliver, D. K., Galey, J., Sebastianelli, M. E., Scally, J. P., Taylor, A. J., & Boal, T. R. (2006). Use of beta-blockers and aspirin after myocardial infarction by patient renal function in the Department of Defense health care system. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 47(4), 593-603.
Abbott KC, et al. Use of Beta-blockers and Aspirin After Myocardial Infarction By Patient Renal Function in the Department of Defense Health Care System. Am J Kidney Dis. 2006;47(4):593-603. PubMed PMID: 16564937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of beta-blockers and aspirin after myocardial infarction by patient renal function in the Department of Defense health care system. AU - Abbott,Kevin C, AU - Bohen,Erin M, AU - Yuan,Christina M, AU - Yeo,Frederick E, AU - Sawyers,Eric S, AU - Perkins,Robert M, AU - Lentine,Krista L, AU - Oliver,David K, AU - Galey,Joanie, AU - Sebastianelli,Mary E, AU - Scally,John P, AU - Taylor,Allen J, AU - Boal,Thomas R, PY - 2005/11/03/received PY - 2006/01/11/accepted PY - 2006/3/28/pubmed PY - 2006/5/24/medline PY - 2006/3/28/entrez SP - 593 EP - 603 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 47 IS - 4 N2 - BACKGROUND: Whether the previously reported underutilization of standard-of-care medications in the management of patients with acute myocardial infarction (AMI) persists in more recent years or differs by ward of admission has not been reported. METHODS: We performed a retrospective cross-sectional study of patients hospitalized with a discharge diagnosis of incident AMI to a Department of Defense hospital (Walter Reed Army Medical Center, Washington, DC) from 2001 through 2004. Use of beta-blockers and aspirin at the time of discharge after AMI was assessed according to Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rate (eGFR) in milliliters per minute per 1.73 m2, stratified by admission to the coronary care unit (CCU) versus other wards. Adjusted odds ratios for discharge beta-blocker and aspirin therapy were calculated by using logistic regression. RESULTS: Among 431 patients, overall discharge use of beta-blockers was 86.8%, and aspirin, 86.8%, both significantly greater after CCU admission than admission to other wards (93%, aspirin use; 91.7%, beta-blocker use; P < 0.001 and P < 0.001). In logistic regression, CCU admission was the only independent factor associated with either beta-blocker or aspirin use; MDRD eGFR was not associated significantly with beta-blocker and aspirin use regardless of admission to the CCU or non-CCU. CONCLUSION: Future studies of disparities in use of standard-of-care medications after AMI according to renal function should account for the primary site of admission, particularly CCU versus others. In addition, legitimate contraindications to the use of beta-blockers and aspirin may be subtle, including appropriate end-of-life decisions. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16564937/Use_of_beta_blockers_and_aspirin_after_myocardial_infarction_by_patient_renal_function_in_the_Department_of_Defense_health_care_system_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(06)00068-0 DB - PRIME DP - Unbound Medicine ER -