TY - JOUR
T1 - Hospital Performance and Differences by Kidney Function in the Use of Recommended Therapies After Non-ST-Elevation Acute Coronary Syndromes
AU - Patel, Uptal D.
AU - Ou, Fang Shu
AU - Ohman, E. Magnus
AU - Gibler, W. Brian
AU - Pollack, Charles V.
AU - Peterson, Eric D.
AU - Roe, Matthew T.
N1 - Funding Information:
Financial Disclosure: Dr Ohman reports having received research grants from Millennium Pharmaceuticals Inc, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, Schering Corp, and Berlex; Dr Gibler reports having received research grants from Millennium Pharmaceuticals Inc, Schering Corp, and Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; Dr Pollack Jr is on the Speakers Bureau for Millennium Pharmaceuticals Inc, Schering Corp, Genentech, and Aventis; receives research support from Aventis; and serves as a consultant for Genentech, Aventis, and Millennium Pharmaceuticals Inc. Dr Peterson reports having received research grants from Bristol-Myers Squibb, Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, Bristol-Myers Squibb/Merck, and Schering-Plough Corp. Dr Roe is on the Speakers' Bureau for Millennium Pharmaceuticals Inc, Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, and Schering Corp and reports having received research grants from Millennium Pharmaceuticals Inc, Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, and Schering Corp. The remaining authors report that they have no financial interests to disclose.
Funding Information:
Support: This study was supported by CRUSADE, a National Quality Improvement Initiative of the Duke Clinical Research Institute, which was funded by the Schering-Plough Corp (Kenilworth, NJ), and Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership (New York, NY). Millennium Pharmaceuticals (Cambridge, MA) provided additional funding support. The sponsors' support was financial, and none of the sponsors had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript. Drs Patel, Roe, and Peterson and Ms Ou had full access to all data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Dr Patel is the recipient of Grant K23 DK075929-01 from the National Institutes of Diabetes and Digestive and Kidney Diseases. Dr Peterson is the recipient of Grant R01 AG025312-01A1 from the National Institute on Aging.
PY - 2009/3
Y1 - 2009/3
N2 - Background: Chronic kidney disease (CKD) is associated with an increased risk of cardiac events and death; however, underuse of guideline-recommended therapies is widespread. The extent to which hospital performance affects the care of patients with CKD and non-ST-segment elevation acute coronary syndromes (NSTE ACSs) is unknown. Study Design: Observational cohort. Setting & Participants: 81,374 patients with NSTE ACSs treated at 327 US hospitals. Predictor: Hospital performance, measured by quartiles of composite adherence to American Heart Association class I guidelines for therapy acutely (aspirin, β-blockers, clopidogrel, heparin, and glycoprotein IIb/IIIa inhibitors) and at discharge (aspirin, clopidogrel, angiotensin-converting enzyme inhibitors, and lipid-lowering agents) in eligible patients. Outcomes & Measurements: Use of each American Heart Association class I acute and discharge therapy stratified by continuous estimated glomerular filtration rate (eGFR). Multivariable models were adjusted for demographics, clinical factors, and hospital features. Results: Better-performing hospitals had lower prescribing rates for most therapies (5 of 9) with lower levels of kidney function, whereas lower-performing hospitals were more likely to have similar prescribing rates across the eGFR spectrum, suggesting that prescribing patterns at these hospitals were insensitive to differences in eGFR. Limitations: Observational design, selection bias of study cohort. Conclusion: Patients with lower levels of kidney function admitted with NSTE ACSs are less likely to receive evidence-based therapies. Treatment disparities related to CKD are most evident at top-performing hospitals.
AB - Background: Chronic kidney disease (CKD) is associated with an increased risk of cardiac events and death; however, underuse of guideline-recommended therapies is widespread. The extent to which hospital performance affects the care of patients with CKD and non-ST-segment elevation acute coronary syndromes (NSTE ACSs) is unknown. Study Design: Observational cohort. Setting & Participants: 81,374 patients with NSTE ACSs treated at 327 US hospitals. Predictor: Hospital performance, measured by quartiles of composite adherence to American Heart Association class I guidelines for therapy acutely (aspirin, β-blockers, clopidogrel, heparin, and glycoprotein IIb/IIIa inhibitors) and at discharge (aspirin, clopidogrel, angiotensin-converting enzyme inhibitors, and lipid-lowering agents) in eligible patients. Outcomes & Measurements: Use of each American Heart Association class I acute and discharge therapy stratified by continuous estimated glomerular filtration rate (eGFR). Multivariable models were adjusted for demographics, clinical factors, and hospital features. Results: Better-performing hospitals had lower prescribing rates for most therapies (5 of 9) with lower levels of kidney function, whereas lower-performing hospitals were more likely to have similar prescribing rates across the eGFR spectrum, suggesting that prescribing patterns at these hospitals were insensitive to differences in eGFR. Limitations: Observational design, selection bias of study cohort. Conclusion: Patients with lower levels of kidney function admitted with NSTE ACSs are less likely to receive evidence-based therapies. Treatment disparities related to CKD are most evident at top-performing hospitals.
KW - Chronic kidney disease
KW - acute coronary syndrome
KW - cardiovascular medications
KW - practice guidelines
KW - quality of care
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U2 - 10.1053/j.ajkd.2008.09.024
DO - 10.1053/j.ajkd.2008.09.024
M3 - Article
C2 - 19100672
AN - SCOPUS:60149105686
SN - 0272-6386
VL - 53
SP - 426
EP - 437
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -