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The association between renal insufficiency, phamacotherapy, and outcomes in 6427 patients with heart failure and coronary artery disease.

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dc.contributor.authorTonelli, M.
dc.contributor.authorEzekowitz, J.
dc.contributor.authorGhali, W.A.
dc.contributor.authorHumphries, K.H.
dc.contributor.authorNorris, C.M.
dc.contributor.authorMcAlister, F. A.
dc.contributor.authorKnudtson, M.L.
dc.date.accessioned2025-05-01T11:39:35Z
dc.date.available2025-05-01T11:39:35Z
dc.date.issued2004
dc.descriptionObjectives This study was designed to examine the use of cardiovascular medications and outcomes in patients with heart failure (HF) and renal dysfunction. Background Renal insufficiency is associated with poorer outcomes in patients with HF, but the mechanisms are uncertain. In particular, the degree of therapeutic nihilism in these patients, and whether it is appropriate, is unclear. Methods This was a prospective cohort study with a one-year follow-up. Results In 6,427 patients with cardiologist-diagnosed HF and angiographically proven coronary artery disease (mean age 69 years; 65% men; one-year mortality, 10%), 39% had creatinine clearances <60 ml/min. Patients with renal insufficiency were less likely to be prescribed angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, statins, or aspirin (all p < 0.001). However, users of aspirin (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57 to 0.85), statins (OR 0.79, 95% CI 0.64 to 0.97), and beta-blockers (OR 0.75, 95% CI 0.62 to 0.90) were less likely to die in the subsequent 12 months than nonusers, irrespective of renal function (all OR adjusted for covariates including atherosclerotic burden and ejection fraction). Although ACE inhibitor users with creatinine clearances ≥60 ml/min had lower 12-month mortality (OR 0.72, 95% CI 0.48 to 0.99), ACE inhibitor users with clearances <60 ml/min did not (OR 1.21, 95% CI 0.97 to 1.51). Conclusions Renal insufficiency is common in patients with HF and coronary artery disease, and these patients have more advanced coronary atherosclerosis. Patients with renal insufficiency are less likely to be prescribed efficacious therapies, but have better outcomes if they receive these medications.
dc.identifier.doihttps://doi.org/10.7939/R3DW0J
dc.language.isoen
dc.relation.isversionofEzekowitz J, McAlister FA, Humphries KH, Norris CM, Tonelli M, Ghali WA. The association between renal insufficiency, phamacotherapy, and outcomes in 6427 patients with heart failure and coronary artery disease. Journal of the American College of Cardiology 44.8 (2004), 1587:1592.
dc.rights© 2004 Elsevier. This version of this article is open access and can be downloaded and shared. The original author(s) and source must be cited.
dc.subjectCardiovascular medications
dc.subjectRenal insufficiency
dc.subjectCoronary artery disease
dc.subjectNursing research
dc.titleThe association between renal insufficiency, phamacotherapy, and outcomes in 6427 patients with heart failure and coronary artery disease.
dc.typehttp://purl.org/coar/resource_type/c_6501 http://purl.org/coar/version/c_970fb48d4fbd8a85
ual.jupiterAccesshttp://terms.library.ualberta.ca/public

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