Use of Beta-Blockers and Aspirin in Acute Coronary Syndromes by Patient Renal Function in the Military Healthcare Systems, National Capital Area
Final rept. 15 Jul 2003-30 Sep 2005
WALTER REED ARMY MEDICAL CENTER WASHINGTON DC
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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 mgdl, 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 pO.035. Contraindications to ASA, but not BB use, were frequent among patients admitted to other wards and with serum creatinine 2.5 mgdl. 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.
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