Data-driven insights and solutions for the health and human resource crisis in Canada
Myran D, Gibb M, Kendall C, Simpson A, Sood M, Backman C, Tranmer J, Tanuseputro P. Healthc Q. 2024; 27(2).
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.
Meraz-Muñoz AY, Jeyakumar N, Luo B, Beaubien-Souligny W, Chanchlani R, Clark EG, Harel Z, Kitchlu A, Neyra JA, Zappitelli M, Chertow GM, Garg AX, Wald R, Silver SA. Kidney Int Rep. . 2022; 8(2):294-304. Epub 2022 Nov 2.
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