Cardioprotective medication use after acute myocardial infarction in kidney transplant recipients

Krista L. Lentine, Todd C. Villines, Huiling Xiao, Mark A. Schnitzler, Daniel C. Brennan, Kevin C. Abbott, Paul J. Hauptman

Research output: Contribution to journalArticle

Abstract

Background: Limited data are available on the use of potentially cardioprotective medications among U.S. kidney transplant recipients. Methods: We constructed a database wherein Organ Procurement and Transplant Network identifiers for kidney transplant recipients were linked to billing records of a private health insurer (2003-2006 claims). Transplant recipients and general beneficiaries with acute myocardial infarction (AMI) events were identified by diagnosis codes. The healthcare process measures of interest comprised prescription fills for beta-blockers, antiplatelet drugs, angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers, and β-hydroxy-β- methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) within 60 days after AMI. Medication use was compared in transplant and general patients by multivariable regression and by one-to-one matching for demographic and clinical factors including comorbidities and revascularization status. Results: We identified 192 kidney transplant recipients and 52,021 general patients who survived with insurance benefits more than or equal to 60 days after AMI diagnosis. In multiple logistic regression, transplant status was independently associated with increased likelihood of beta-blocker (adjusted odds ratio, 2.50; 95% confidence interval, 1.70-3.68; P<0.0001) and statin (adjusted odds ratio, 1.78; 95% confidence interval, 1.28-2.48; P=0.0006) use after AMI. Similarly kidney transplant recipients with AMI more commonly received beta-blockers (83.0% vs. 65.9%; P=0.0001) and statins (72.0% vs. 62.6%; P=0.04) compared with matched controls. Use of antiplatelet agents and angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers did not differ significantly by transplant status. Conclusions: Although kidney transplant status does not seem to be a barrier to medication use after AMI, there may be opportunities for improving cardiovascular risk management in high-risk transplant recipients. Administrative records offer a practical tool for monitoring cardiovascular complications and healthcare delivery not tracked in national registries.

Original languageEnglish (US)
Pages (from-to)1120-1126
Number of pages7
JournalTransplantation
Volume91
Issue number10
DOIs
StatePublished - May 27 2011
Externally publishedYes

Keywords

  • Billing claims
  • Kidney transplantation
  • Myocardial infarction
  • Prescription drugs
  • Registries

ASJC Scopus subject areas

  • Transplantation

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  • Cite this

    Lentine, K. L., Villines, T. C., Xiao, H., Schnitzler, M. A., Brennan, D. C., Abbott, K. C., & Hauptman, P. J. (2011). Cardioprotective medication use after acute myocardial infarction in kidney transplant recipients. Transplantation, 91(10), 1120-1126. https://doi.org/10.1097/TP.0b013e31821570c8