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Attainment of Guideline-Directed Medical Treatment in Stable Ischemic Heart Disease Patients With and Without Chronic Kidney Disease

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Abstract

Background

Stable ischemic heart disease (SIHD) is prevalent in patients with chronic kidney disease (CKD); however, whether guideline-directed medical therapy (GDMT) is adequately implemented in patients with SIHD and CKD is unknown.

Hypothesis

Use of GDMT and achievement of treatment targets would be higher in SIHD patients without CKD than in patients with CKD.

Methods

This was a retrospective study of 563 consecutive patients with SIHD (mean age 67.8 years, 84% Caucasians, 40% females). CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73m2 using the four-variable MDRD Study equation. We examined the likelihood of achieving GDMT targets (prescription of high-intensity statins, antiplatelet agents, renin-angiotensin-aldosterone system inhibitors (RAASi), and low-density lipoprotein cholesterol levels < 70 mg/dL, blood pressure < 140/90 mmHg, and hemoglobin A1C < 7% if diabetes) in patients with (n = 166) and without CKD (n = 397).

Results

Compared with the non-CKD group, CKD patients were significantly older (72 vs 66 years; p < 0.001), more commonly female (49 vs 36%; p = 0.002), had a higher prevalence of diabetes (46 vs 34%; p = 0.004), and left ventricular systolic ejection fraction (LVEF) < 40% (23 vs. 10%, p < 0.001). All GDMT goals were achieved in 26% and 24% of patients with and without CKD, respectively (p = 0.712). There were no between-group differences in achieving individual GDMT goals with the exception of RAASi (CKD vs non-CKD: adjusted risk ratio 0.73, 95% CI 0.62–0.87; p < 0.001).

Conclusions

Attainment of GDMT goals in SIHD patients with CKD was similar to patients without CKD, with the exception of lower rates of RAASi use in the CKD group.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA

    Efstratios Koutroumpakis

  2. Division of Nephrology and Hypertension, Department of Medicine, Albany Medical College, Albany, NY, USA

    Elvira O. Gosmanova

  3. Nephrology Section, Stratton VA Medical Center, Albany, NY, USA

    Elvira O. Gosmanova

  4. Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA

    Heather Stahura, Stephanie Jou, Rabah Alreshq, Mandeep S. Sidhu, Edward Philbin & Radmila Lyubarova

  5. Department of General Surgery, Albany Medical College, Albany, NY, USA

    Ashar Ata

  6. Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), VA New England Healthcare System, Boston, MA, USA

    William E. Boden

  7. Boston University School of Medicine, Boston, MA, USA

    William E. Boden

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  1. Efstratios Koutroumpakis
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  2. Elvira O. Gosmanova
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  3. Heather Stahura
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Correspondence to Radmila Lyubarova.

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Conflict of Interest

The authors declare no conflicts of interest. EEG and WEB are employees of the Department of Veterans affairs. Opinions expressed in this paper are those of the authors’ and do not necessarily represent the opinion of the Department of Veterans Affairs. The results of this paper have not been published previously in whole or part.

Ethical Approval

This article is based on retrospective patient chart review and does not contain any studies with human participants or animals performed by any of the authors. Our study was approved by the institutional review board of Albany Medical College.

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Koutroumpakis, E., Gosmanova, E.O., Stahura, H. et al. Attainment of Guideline-Directed Medical Treatment in Stable Ischemic Heart Disease Patients With and Without Chronic Kidney Disease. Cardiovasc Drugs Ther 33, 443–451 (2019). https://doi.org/10.1007/s10557-019-06883-z

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  • DOI: https://doi.org/10.1007/s10557-019-06883-z

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