Author + information
- Received October 31, 2002
- Revision received February 7, 2003
- Accepted February 13, 2003
- Published online July 16, 2003.
- ↵*Reprint requests and correspondence:
Dr. Alan K. Berger, Division of Epidemiology, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, Minnesota 55454, USA.
Objectives We sought to examine the use and impact of standard medical therapies in patients with end-stage renal disease (ESRD) faced with an acute myocardial infarction (AMI).
Background The poor prognosis of patients in this high-risk population has become increasingly well recognized.
Methods Using the ESRD database and the Cooperative Cardiovascular Project (CCP) database, we identified AMI patients who were receiving either peritoneal dialysis or hemodialysis before admission. The early administration of aspirin and beta-blockers was compared between ESRD and non-ESRD patients and the effect of these therapies on 30-day mortality was evaluated with logistic regression models.
Results The cohort consisted of 145,740 patients without ESRD and 1,025 patients with ESRD. Aspirin (67.0% vs. 82.4%, p < 0.001), beta-blockers (43.2% vs. 50.8%, p < 0.001), and angiotensin-converting enzyme (ACE) inhibitors (38.5% vs. 60.3%, p < 0.001) were less likely to be administered to ESRD patients than to non-ESRD patients. The benefit of these therapies on 30-day mortality was similar among ESRD patients (aspirin: relative risk [RR] 0.64; 95% confidence interval [CI] 0.50 to 0.80; beta-blocker: RR 0.78; 95% CI 0.60 to 0.99; ACE inhibitor: RR 0.58; 95% CI 0.42 to 0.77) and non-ESRD patients (aspirin: RR 0.57; 95% CI 0.55 to 0.58; beta-blocker: RR 0.70; 95% CI 0.68 to 0.72; ACE inhibitor: RR 0.64; 95% CI 0.63 to 0.66).
Conclusions End-stage renal disease patients are far less likely than non-ESRD patients to be treated with aspirin, beta-blockers, and ACE inhibitors during an admission for AMI. The lower rates of usage for these medications, particularly aspirin, may contribute to the increased 30-day mortality. These findings demonstrate a marked opportunity to improve care in this population.
☆ Supported in part by Georgetown University (Washington, DC) and by the Delmarva Foundation for Medical Care, Inc. (Easton, Maryland). The analyses upon which this publication is based were performed under contract numbers 500-96-P623 and 500-96-P624, entitled “Utilization and Quality Control Peer Review Organization for the State of Maryland and the District of Columbia,” sponsored by the Delmarva Foundation for Medical Care, Inc., and the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The Health Care Quality Improvement Program (HCQIP), initiated by CMS, encourages identification of quality improvement projects derived from the analysis of patterns of care. The Cooperative Cardiovascular Project (CCP), the focus of this manuscript, represents a project within the HCQIP. The authors assume full responsibility for the accuracy and completeness of the ideas expressed in this manuscript.
- Received October 31, 2002.
- Revision received February 7, 2003.
- Accepted February 13, 2003.
- American College of Cardiology Foundation