Cardiovascular drug use after acute kidney injury among hospitalized patients with a history of myocardial infarction

Introduction — Patients who survive acute kidney injury (AKI) may receive fewer cardioprotective drugs. Our objective was to measure the difference in time to dispensing evidence-based cardiovascular drugs in patients with a history of MI with and without AKI.

Methods — Population-based cohort study of ≥ 66 years-old patients with history of MI who survived a hospitalization complicated with AKI, propensity-score matched to patients without AKI. The primary outcome was time to outpatient dispensing of an angiotensin-converting enzyme inhibitor/angiotensin-II receptor-blocker (ACEi/ARB), statin or beta-blockers within one year of hospital discharge.

Results — We identified 28,871 patients with AKI, of whom 21,452 were matched 1:1 to patients without AKI. In the matched cohort, mean age was 80 years, 40% were female, and 34% had a MI during the index hospitalization. AKI was associated with less frequent dispensing of all three cardiovascular drug classes within one year of hospital discharge (sHR=0.93, 95% CI 0.91-0.95). This association was most pronounced in patients with stage 2 (sHR=0.81, 95% CI 0.75-0.88) and 3 AKI (sHR=0.71, 95% CI 0.64-0.79). We observed less frequent dispensing of statins in patients with stage 2 (sHR=0.87, 95% CI 0.81-0.92) and 3 AKI (sHR=0.85, 95% CI 0.78-0.93), and less frequent dispensing of beta-blockers in patients with stage 3 AKI (sHR=0.86, 95% CI 0.79-0.94).

Conclusions — In patients with a history of MI, survivors of AKI were less likely to receive prescriptions for ACEi/ARB, statins, or beta-blockers within one year of hospital discharge. This association was most pronounced in patients with stage 2 and 3 AKI.