Use of Beta-Blockers and Aspirin in Acute Coronary Syndromes by Patient Renal Function in the Military Healthcare Systems, National Capital Area

摘要

Whether the previously reported underutilization of standard-of-care medications in the management of acute myocardial infarcton (AMI) persists in more recent years or differs by ward of admission has not been reported. We performed a cross-sectional study of patients admitted with initial episodes of AMI to a Department of Defense (DOD) hospital system from 2001 through 2004. Use of beta-blockers (BB) and aspirin (ASA) at the time of discharge after AMI was assessed according to serum creatinine level, stratified by admission to the coronary care unit (CCU) vs. other wards. Adjusted odds ratios for discharge BB and ASA were calculated by logistic regression. Among 453 patients, overall use of BB was 84.5% and ASA 83.7%, both significantly higher after CCU admission than admission to otherwards (90.1% ASA and 91.0% BB use; P < 0.001 and P < 0.001). Among CCU patients with the highest quartile of serum creatinine (%1 .6 mg(exclamation point)dl), SB use was 93.3% and ASA use 87.3%. Among non-CCU patients in the highest quartile of serum creatinine, SB use was 68.5% and ASA use was 71.2%. In logistic regression, the log-transformed serum creatinine was significantly associated with BB and ASA use only among non-CCU patients (p=O.035). Contraindications to ASA, but not BB use, were frequent among patients admitted to other wards and with serum creatinine %2.5 mg(exclamation point)dl. In the DOD health system in recent years, admission to the CCU for AMI was not associated with significant underutilization of SB and ASA among patients with renal insufficiency.