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The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention
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Zachariah, D., Brown, R., Kanagala, P., Bashir, A., Mohan, Mohapradeep, Callan, P., Rajendra, R., Clark, A. L., Squire, I., Gunning, M., Lang, C. C. and Kalra, P. R. (2014) The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention. QJM : monthly journal of the Association of Physicians, 107 (3). pp. 185-192. doi:10.1093/qjmed/hct222 ISSN 1460-2393.
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Official URL: https://doi.org/10.1093/qjmed/hct222
Abstract
Objective: Historical data suggest elderly patients and those with chronic kidney disease (CKD) receive suboptimal secondary prevention following myocardial infarction (MI). We evaluated the impact of age and CKD on secondary prevention following primary percutaneous coronary intervention (PPCI) in a contemporary unselected cohort.
Design: We studied 1169 consecutive patients from five UK centres receiving PPCI for ST elevation MI, with use of evidence-based secondary prevention at discharge assessed by age (<60, 60–75 and >75 years) and estimated glomerular filtration rate (eGFR). Follow-up prescribing practice was assessed in 567 patients.
Results: One-fifth of patients receiving PPCI were >75 years. This group received fewer secondary prevention drugs at discharge compared to younger patients (P < 0.01 for β-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins). By 6 weeks post-PPCI, there was a small drop-off in evidence-based therapy; β-blocker and statin use in those >75 years fell from 90% to 86% and 96% to 93%, respectively. CKD (eGFR<60 ml/min/1.73 m2) was seen in 17.6%. Declining renal function was associated with age, female sex and lower use of ACE inhibitor/ARB. At discharge 83.5% of patients with eGFR<60 ml/min/1.73 m2 were receiving ACE inhibitors/ARB, dropping to 77.5% at 6 weeks (compared with 95% and 92%, respectively, in patients with eGFR >60 ml/min/1.73 m2).
Conclusions: The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | QJM : monthly journal of the Association of Physicians | ||||
Publisher: | Oxford University Press | ||||
ISSN: | 1460-2393 | ||||
Official Date: | March 2014 | ||||
Dates: |
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Volume: | 107 | ||||
Number: | 3 | ||||
Page Range: | pp. 185-192 | ||||
DOI: | 10.1093/qjmed/hct222 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Description: | Free Access |
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