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Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: a national Veterans
Eric M Gibney1, Adrianne W Casebeer, Lynn M Schooley
1Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, Colorado, USA. eric.gibney@mail2.vcu
Insights
Patients with chronic kidney disease undergoing coronary artery bypass grafting (CABG) received fewer cardiovascular medications. Reduced medication use, especially in those with declining kidney function (estimated glomerular filtration rate [eGFR] <60), was linked to increased mortality risk.
Area of Science:
- Cardiology
- Nephrology
- Health Services Research
Background:
- Chronic kidney disease (CKD) is an independent risk factor for cardiovascular events.
- Understanding medication use patterns in CKD patients post-coronary artery bypass grafting (CABG) is crucial.
- Investigating the impact of comorbid conditions on cardiovascular medication prescription in renal dysfunction is important.
Purpose of the Study:
- To determine if cardiovascular medications are underutilized in patients with renal dysfunction after CABG.
- To assess if decreased medication use is independent of other health conditions.
- To examine the association between cardiovascular medication use and 6-month mortality.
Main Methods:
- Retrospective analysis of 19,411 patients from the National Veterans Administration (VA) Continuous Improvement in Cardiac Surgery Program and pharmacy database.
- Compared prescription rates of beta blockers, lipid-lowering agents, antiplatelet agents, and angiotensin antagonists within 6 months of discharge.
- Analyzed medication utilization across different estimated glomerular filtration rate (eGFR) categories (eGFR >90, 60-90, 30-60, <30).
Main Results:
- Medication nonprescription rates increased significantly with declining eGFR.
- Decreased utilization of cardiovascular medications persisted in patients with eGFR 30-60 and <30, even after adjusting for comorbidities.
- Cardiovascular medication use in patients with eGFR <60 was associated with improved 6-month survival, with cumulative benefits observed for each additional medication class used.
Conclusions:
- Renal disease is strongly associated with significantly decreased cardiovascular medication use in veterans undergoing CABG.
- Nonprescription of these vital medications correlates with adverse outcomes, including increased mortality, in patients with renal dysfunction.
Background:
Chronic kidney disease is now recognized as an independent risk factor for cardiovascular events. We sought to determine if cardiovascular medications were utilized less in patients with renal dysfunction following coronary artery bypass grafting (CABG) and if the association of decreased medication use was independent of comorbid conditions. We also examined associations between cardiovascular medication use and mortality at 6 months.
Methods:
Data from the National Veterans Adminstration (VA) Continuous Improvement in Cardiac Surgery Program were merged with the national VA pharmacy database. Prescription rates within 6 months of discharge for CABG were obtained for four classes of medicines: beta blockers, lipid-lowering agents, antiplatelet agents, and angiotensin antagonists. Utilization of medications in patients with estimated glomerular filtration rate (GFR) 60 to 90, 30 to 60, and <30 were compared with the reference group of GFR >90.
Results:
In a retrospective analysis of 19,411 patients, the frequency of nonprescription increased with declining GFR. Decreased utilization for patients with GFR 30 to 60 and <30 remained highly significant after adjustment for age, race, hypertension, diabetes, and prior myocardial infarction. In patients with more advanced renal dysfunction (GFR <60), cardiovascular medication use for all medication classes was associated with survival at 6 months after adjusting for demographic and clinical variables. Cumulative protection was seen with use of medication from each additional class.
Conclusion:
In a large VA population undergoing CABG, renal disease is associated with highly significant decreases in utilization of cardiovascular medications. Nonprescription of medications was associated with adverse outcomes in those with renal dysfunction.
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