Use of Recommended Medications after Myocardial Infarction—Is Kidney Function Really the Problem?

Abstract

Patients with chronic kidney disease (CKD) suffer the paradox of high risk for heart disease and yet reduced use of standard therapies for treatment and prevention of heart disease. The classic example in the literature is the reduced use of standard of care medications after acute myocardial infarction (AMI), now shown in a variety of settings even where the cost of prescription drugs should be a minimal factor (1,2). Only since 2002 has the Joint Commission on Accreditation of Hospitals (JCAHO) stipulated ORYX core indicators, which recommend the use of aspirin and β blockers in a setting of AMI unless explicitly contraindicated, a timeframe only one study yet published has included (2,3). Are primary care physicians really basing therapy after AMI on kidney function (and in most studies this means serum creatinine)? This seems difficult to believe, especially as many studies indicate that a large proportion of patients admitted for AMI never have serum creatinine levels drawn. If true, this would seem a potentially “easy” fix in this era of electronic medical records and automated reminders. However, perhaps poor kidney function is strongly associated with other factors that lead to reduced use of standard of care medications. The identification of these other potential factors has been only partially addressed by previous studies, and is …