Post-MI care poor in patients on dialysis

Elderly patients on dialysis are likely to receive insufficient cardiovascular care after acute MI, US researchers have found.

Mortality was high among elderly dialysis patients who had an MI, the study showed. Over 40 per cent of 902 dialysis patients aged over 65 who were hospitalised following an MI in two Eastern US states between 1995 and 2003 died within 90 days. Over 60 per cent died within a year.

The standard post-MI therapies are angiotensin receptor blockers (ARBs), statins, ACE inhibitors and beta-blockers.

The researchers looked at which of these drugs the MI dialysis patients were prescribed.

They found that overall prescribing of these standard post-MI therapies to the dialysis patients was low. Only 31 per cent received an ACE inhibitor or ARB, 19 per cent a statin, and 34 per cent a beta-blocker.

Use of ACE inhibitors and ARBs alone or in combination was found to reduce one-year mortality by 30 per cent compared to not receiving them. But statins and beta-blockers had no detectable effect.

The authors concluded that elderly dialysis patients had excessively high mortality and low use of the standard therapies for MI.

- Am J Kidney Dis 2006;47:301-8

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