Use of beta-blockers and aspirin after myocardial infarction by patient renal function in the Department of Defense health care system.
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.


CONCLUSIONS
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.
Nephrology Service, Clinical Information System, Walter Reed Army Medical Center, Washington, DC 20307, USA. kevin.abbott@na.amedd.army.mil
Kevin C
KC
Abbott
Erin M
EM
Bohen
Christina M
CM
Yuan
Frederick E
FE
Yeo
Eric S
ES
Sawyers
Robert M
RM
Perkins
Krista L
KL
Lentine
David K
DK
Oliver
Joanie
J
Galey
Mary E
ME
Sebastianelli
John P
JP
Scally
Allen J
AJ
Taylor
Thomas R
TR
Boal
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D003404:Creatinine; D001241:Aspirin