CKD status does not affect health status outcomes after AMI

By Laura Cowen

Chronic kidney disease (CKD) does not accentuate the decline in health status often experienced by patients after acute myocardial infarction (AMI), US study data show.

Among 3617 survivors of AMI, health‐related quality of life (HRQoL), angina frequency and mental health at 1 year were similar between patients with and without CKD, report Mark Navarro (University of San Francisco - Fresno, California) and colleagues in the Journal of the American Heart Association.

"[T]hese findings suggest that clinicians should treat patients with CKD similarly to patients without CKD because they can achieve similar health status outcomes", they say.

The patients were members of the prospective Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry.

There were several significant baseline differences between the 576 patients with CKD and the 3041 without, including age (67.2 vs 57.8 years) the proportion of men (52 vs 70%) and the degree of comorbidity. CKD patients more often presented with a history of MI, percutaneous coronary intervention and coronary artery bypass grafting.

Furthermore, patients with CKD were significantly more likely to have multivessel coronary disease and were less likely to undergo revascularisation during hospitalisation.

After adjustment for these differences, 1-year survival was significantly lower for patients with CKD than for those without CKD, with a hazard ratio for death of 2.14.

However, the Seattle Angina Questionnaire and the Short Form‐12 survey revealed that the AMI survivors with and without CKD had similar 1-year scores for HRQoL (81.8 vs 81.7), angina frequency (91.4 vs 93.1) and mental health (52.7 vs 51.9).

In contrast, patients with CKD had lower physical health scores than patients without CKD (38.4 vs 44.4), reflecting a statistically significant difference but not a "clinically significant" one, Navarro and co-authors remark.

The authors suggest that the lack of health status differences could be due to CKD patients being less likely to physically exert themselves and therefore elicit anginal symptoms, while differences in HRQoL may be due to lower expectations among patients with CKD.

Navarro et al also note that patients with CKD were less likely to be discharged with aspirin, statins and ACE inhibitors than patients without CKD, despite their well-known benefits.

The reasons for this are unclear and "[m]ore studies are needed to investigate the treatment paradox for patients with CKD", the team concludes.

In an accompanying editorial, Paulette Wehner and William Nitardy, from Marshall University Joan C Edwards School of Medicine in Huntington, West Virginia, USA, congratulate the authors on their clinically important study that shows patients with CKD "should not be denied such proven interventions as cardiac rehabilitation, cardiac support groups, and dietary counseling."

They also voice concerns over the lower discharge medication rates of aspirin, statins and ACE inhibitors for patients with CKD and urge clinicians to "follow the guidelines".

Source: J Am Heart Assoc 2016; Advance online publication

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