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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Kidney Disease and Heart Attacks
1 October 2002 | Volume 137 Issue 7 | Page I-12
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Association of Renal Insufficiency with Treatment and Outcomes after Myocardial Infarction in Elderly Patients." It is in the 1 October 2002 issue of Annals of Internal Medicine (volume 137, pages 555-562). The authors are MG Shlipak, PA Heidenreich, H Noguchi, GM Chertow, WS Browner, and MB McClellan.
What is the problem and what is known about it so far?
Heart attacks occur when the blood flow through the arteries to the heart is blocked for a long enough time to damage or kill a portion of heart muscle. Most heart attacks produce symptoms, such as severe crushing chest pain, nausea, shortness of breath, or a feeling of impending doom. Some people with heart attacks die immediately, before they are able to receive medical attention. Others are admitted to hospitals, where they typically receive several treatments to help prevent death and complications. Activities and conditions that can increase the risk for having a heart attack include a high-fat diet, smoking, a high cholesterol level, high blood pressure, diabetes, and kidney disease. After a heart attack, such factors as severe kidney failure and not getting appropriate treatment increase the risk for death. We do not know whether mild and moderate kidney disease increase the risk for death after a heart attack. We also do not know whether people with and without kidney disease receive the same types of treatments after heart attacks.
Why did the researchers do this particular study?
To describe how patients with kidney disease and heart attack are treated and to see whether kidney disease affects risk for death after heart attack.
Who was studied?
130 099 patients older than 64 years who received Medicare benefits. All had been admitted from a hospital between April 1994 and July 1995 with a diagnosis of heart attack.
How was the study done?
Researchers reviewed hospital records to identify older adults with heart attacks and either normal kidney function or mild and moderate kidney disease. They did not study patients with severe kidney failure. The researchers reviewed the therapies that were given to the patients in the hospital and at discharge. They also reviewed government records (Social Security Administration records) to identify patients who died within 1 year of being hospitalized for a heart attack. The researchers then compared treatments and 1-year death rates among patients with and without kidney disease.
What did the researchers find?
Death rates at 1 year were 66% for patients with moderate kidney disease (serum creatinine level > 2.4 mg/dL), 46% for those with mild kidney disease (serum creatinine level,1.5 to 2.4 mg/dL), and 24% for those with no kidney disease (serum creatinine level < 1.5 mg/dL). Moderate kidney disease was more common in black persons and men as well as patients with diabetes or a previous stroke. Patients with normal kidney function received typical treatments for heart attacks (aspirin, ß-blocker drugs, clot buster drugs, and special heart procedures) much more often than those with moderate kidney disease.
What were the limitations of the study?
The study included only older adults with normal kidneys or mild and moderate kidney disease. Middle-aged adults may have better outcomes after a heart attack than do older adults; people with severe kidney problems may have worse outcomes.
What are the implications of the study?
Older patients with mild and moderate kidney disease have higher 1-year death rates after heart attacks than those without kidney disease. They also receive fewer effective treatments for heart attacks, which may explain the higher death rates.
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