title: Cardioprotective medication use after acute myocardial infarction in kidney transplant recipients.
abstract: BACKGROUND
  Limited data are available on the use of potentially cardioprotective medications among U.S. kidney transplant recipients.
  
  
  METHODS
  We constructed a database wherein Organ Procurement and Transplant Network identifiers for kidney transplant recipients were linked to billing records of a private health insurer (2003-2006 claims). Transplant recipients and general beneficiaries with acute myocardial infarction (AMI) events were identified by diagnosis codes. The healthcare process measures of interest comprised prescription fills for beta-blockers, antiplatelet drugs, angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers, and β-hydroxy-β-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) within 60 days after AMI. Medication use was compared in transplant and general patients by multivariable regression and by one-to-one matching for demographic and clinical factors including comorbidities and revascularization status.
  
  
  RESULTS
  We identified 192 kidney transplant recipients and 52,021 general patients who survived with insurance benefits more than or equal to 60 days after AMI diagnosis. In multiple logistic regression, transplant status was independently associated with increased likelihood of beta-blocker (adjusted odds ratio, 2.50; 95% confidence interval, 1.70-3.68; P<0.0001) and statin (adjusted odds ratio, 1.78; 95% confidence interval, 1.28-2.48; P=0.0006) use after AMI. Similarly kidney transplant recipients with AMI more commonly received beta-blockers (83.0% vs. 65.9%; P=0.0001) and statins (72.0% vs. 62.6%; P=0.04) compared with matched controls. Use of antiplatelet agents and angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers did not differ significantly by transplant status.
  
  
  CONCLUSIONS
  Although kidney transplant status does not seem to be a barrier to medication use after AMI, there may be opportunities for improving cardiovascular risk management in high-risk transplant recipients. Administrative records offer a practical tool for monitoring cardiovascular complications and healthcare delivery not tracked in national registries.
authors.affiliation: Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO 63104, USA. lentinek@slu.edu
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000209:etiology*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D002317:Cardiovascular Agents