Management and outcomes of myocardial infarction in people with impaired kidney function in England

Jemima Scott; Patrick Bidulka; Dominic M Taylor; Udaya Udayaraj; Fergus J Caskey; Kate Birnie; John Deanfield; Mark de Belder; Spiros Denaxas; Clive Weston; David Adlam; Dorothea Nitsch

doi:10.1186/s12882-023-03377-x

Management and outcomes of myocardial infarction in people with impaired kidney function in England

Jemima Scott
, Patrick Bidulka
, Dominic M Taylor
, Udaya Udayaraj
, Fergus J Caskey
, Kate Birnie
, John Deanfield
, Mark de Belder
, Spiros Denaxas
, Clive Weston
, David Adlam
, Dorothea Nitsch

Research output: Contribution to journal › Article (Academic Journal) › peer-review

10 Citations (Scopus)

Abstract

BACKGROUND: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK.

METHODS: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017.

RESULTS: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people.

CONCLUSIONS: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.

Original language	English
Article number	325
Pages (from-to)	325
Journal	BMC Nephrology
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s12882-023-03377-x
Publication status	Published - 2 Nov 2023

Bibliographical note

Funding Information:
All authors have completed an ICJME form. PB, DMT, FJC, KB, MDB, and SD have nothing to declare. UU declares a grant from the Health Foundation to undertake quality improvement unrelated to this work. MS declares funding from Cancer Research UK (C53325/A21134) and British Heart Foundation (SP/16/5/32415) for research activities related to this work looking at acute myocardial infarction ascertainment in a cancer population. JS declares Doctoral research funding from the NIHR for related research looking at acute myocardial infarction care for people with chronic kidney disease. JD declares grants from British Heart Foundation paid to his institution unrelated to this work. JD also declares consulting fees from Novo Nordisk, and honoraria from Amgen, Boehringer Ingelheim, Merck, Pfizer, Aegerion, Novartis, Sanofi, Takeda, Novo Nordisk, and Bayer, unrelated to this work. JD is also member of a study steering committee with Novo Nordisk. CW declares he is clinical lead of the Myocardial Ischaemia National Audit Project. DA reports research funding and in-kind support from Astra Zeneca inc. for unrelated research and educational funding from Abbott Vascular inc. to support a clinical research fellow doing unrelated research. DA has conducted consultancy for General Electric inc. to support general research funds. DN is the UK Kidney Association Director of Informatics Research. DN is also on the steering group for two GlaxoSmithKline funded studies that investigate kidney function in children and adults in Sub-Saharan Africa.

Funding Information:
MINAP, as part of the ‘National Cardiac Audit Project’, was previously commissioned by the Healthcare Quality Improvement Partnership although more recently the National Cardiac Audit Programme has been moved within NHS England. The data used in this study were provided with HQIP’s approval. This work uses data that has been provided by patients and collected by the NHS as part of their care and support. We acknowledge and thank UK cardiovascular, renal, and primary care physicians as well as hospital and community audit and coding teams whose diligent data collection has provided the data for these analyses. In particular, we would like to thank James Chal, Anil Gunesh, Andrew Harrison, and Akosua Donkor from NICOR; and Kathryn Griffith, Matthew Harker, Yvonne Silove, Tasneem Hoosain, Nick Wilson, Ronnie Moodley, Richard Fluck, Chris Gush, David Wheeler, Liam Smeeth, Ron Cullen, Andy Syme, Richard Gunn, Paul Wright, Hugh Gallagher, Sion Edwards, Fiona Loud, Nick Palmer, Richard Fluck, Anita Sharma, Kate Cheema, Andy Syme, Sally Hull, Ben Caplin, Lois Kim, and Faye Cleary from the NCKDA steering, clinical reference, and statistical groups.

Funding Information:
This work was supported by Kidney Research UK (grant number IN_008_20180304) and the Health Foundation (grant number 1725841). JS is a Doctoral Research Fellow funded by the NIHR (NIHR 300906). DA is funded by a joint research grant from the British Heart Foundation (SP/16/5/32415) and Cancer Research UK (C53325/A21134).

Publisher Copyright:
© 2023, The Author(s).

Keywords

Humans
ST Elevation Myocardial Infarction/epidemiology
Treatment Outcome
Risk Factors
Myocardial Infarction/epidemiology
Renal Insufficiency/complications
Kidney
Percutaneous Coronary Intervention

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Cite this

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title = "Management and outcomes of myocardial infarction in people with impaired kidney function in England",

abstract = "BACKGROUND: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK.METHODS: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017.RESULTS: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people.CONCLUSIONS: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.",

keywords = "Humans, ST Elevation Myocardial Infarction/epidemiology, Treatment Outcome, Risk Factors, Myocardial Infarction/epidemiology, Renal Insufficiency/complications, Kidney, Percutaneous Coronary Intervention",

author = "Jemima Scott and Patrick Bidulka and Taylor, \{Dominic M\} and Udaya Udayaraj and Caskey, \{Fergus J\} and Kate Birnie and John Deanfield and \{de Belder\}, Mark and Spiros Denaxas and Clive Weston and David Adlam and Dorothea Nitsch",

note = "Funding Information: All authors have completed an ICJME form. PB, DMT, FJC, KB, MDB, and SD have nothing to declare. UU declares a grant from the Health Foundation to undertake quality improvement unrelated to this work. MS declares funding from Cancer Research UK (C53325/A21134) and British Heart Foundation (SP/16/5/32415) for research activities related to this work looking at acute myocardial infarction ascertainment in a cancer population. JS declares Doctoral research funding from the NIHR for related research looking at acute myocardial infarction care for people with chronic kidney disease. JD declares grants from British Heart Foundation paid to his institution unrelated to this work. JD also declares consulting fees from Novo Nordisk, and honoraria from Amgen, Boehringer Ingelheim, Merck, Pfizer, Aegerion, Novartis, Sanofi, Takeda, Novo Nordisk, and Bayer, unrelated to this work. JD is also member of a study steering committee with Novo Nordisk. CW declares he is clinical lead of the Myocardial Ischaemia National Audit Project. DA reports research funding and in-kind support from Astra Zeneca inc. for unrelated research and educational funding from Abbott Vascular inc. to support a clinical research fellow doing unrelated research. DA has conducted consultancy for General Electric inc. to support general research funds. DN is the UK Kidney Association Director of Informatics Research. DN is also on the steering group for two GlaxoSmithKline funded studies that investigate kidney function in children and adults in Sub-Saharan Africa. Funding Information: MINAP, as part of the {\textquoteleft}National Cardiac Audit Project{\textquoteright}, was previously commissioned by the Healthcare Quality Improvement Partnership although more recently the National Cardiac Audit Programme has been moved within NHS England. The data used in this study were provided with HQIP{\textquoteright}s approval. This work uses data that has been provided by patients and collected by the NHS as part of their care and support. We acknowledge and thank UK cardiovascular, renal, and primary care physicians as well as hospital and community audit and coding teams whose diligent data collection has provided the data for these analyses. In particular, we would like to thank James Chal, Anil Gunesh, Andrew Harrison, and Akosua Donkor from NICOR; and Kathryn Griffith, Matthew Harker, Yvonne Silove, Tasneem Hoosain, Nick Wilson, Ronnie Moodley, Richard Fluck, Chris Gush, David Wheeler, Liam Smeeth, Ron Cullen, Andy Syme, Richard Gunn, Paul Wright, Hugh Gallagher, Sion Edwards, Fiona Loud, Nick Palmer, Richard Fluck, Anita Sharma, Kate Cheema, Andy Syme, Sally Hull, Ben Caplin, Lois Kim, and Faye Cleary from the NCKDA steering, clinical reference, and statistical groups. Funding Information: This work was supported by Kidney Research UK (grant number IN\_008\_20180304) and the Health Foundation (grant number 1725841). JS is a Doctoral Research Fellow funded by the NIHR (NIHR 300906). DA is funded by a joint research grant from the British Heart Foundation (SP/16/5/32415) and Cancer Research UK (C53325/A21134). Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = nov,

day = "2",

doi = "10.1186/s12882-023-03377-x",

language = "English",

volume = "24",

pages = "325",

journal = "BMC Nephrology",

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TY - JOUR

T1 - Management and outcomes of myocardial infarction in people with impaired kidney function in England

AU - Scott, Jemima

AU - Bidulka, Patrick

AU - Taylor, Dominic M

AU - Udayaraj, Udaya

AU - Caskey, Fergus J

AU - Birnie, Kate

AU - Deanfield, John

AU - de Belder, Mark

AU - Denaxas, Spiros

AU - Weston, Clive

AU - Adlam, David

AU - Nitsch, Dorothea

N1 - Funding Information: All authors have completed an ICJME form. PB, DMT, FJC, KB, MDB, and SD have nothing to declare. UU declares a grant from the Health Foundation to undertake quality improvement unrelated to this work. MS declares funding from Cancer Research UK (C53325/A21134) and British Heart Foundation (SP/16/5/32415) for research activities related to this work looking at acute myocardial infarction ascertainment in a cancer population. JS declares Doctoral research funding from the NIHR for related research looking at acute myocardial infarction care for people with chronic kidney disease. JD declares grants from British Heart Foundation paid to his institution unrelated to this work. JD also declares consulting fees from Novo Nordisk, and honoraria from Amgen, Boehringer Ingelheim, Merck, Pfizer, Aegerion, Novartis, Sanofi, Takeda, Novo Nordisk, and Bayer, unrelated to this work. JD is also member of a study steering committee with Novo Nordisk. CW declares he is clinical lead of the Myocardial Ischaemia National Audit Project. DA reports research funding and in-kind support from Astra Zeneca inc. for unrelated research and educational funding from Abbott Vascular inc. to support a clinical research fellow doing unrelated research. DA has conducted consultancy for General Electric inc. to support general research funds. DN is the UK Kidney Association Director of Informatics Research. DN is also on the steering group for two GlaxoSmithKline funded studies that investigate kidney function in children and adults in Sub-Saharan Africa. Funding Information: MINAP, as part of the ‘National Cardiac Audit Project’, was previously commissioned by the Healthcare Quality Improvement Partnership although more recently the National Cardiac Audit Programme has been moved within NHS England. The data used in this study were provided with HQIP’s approval. This work uses data that has been provided by patients and collected by the NHS as part of their care and support. We acknowledge and thank UK cardiovascular, renal, and primary care physicians as well as hospital and community audit and coding teams whose diligent data collection has provided the data for these analyses. In particular, we would like to thank James Chal, Anil Gunesh, Andrew Harrison, and Akosua Donkor from NICOR; and Kathryn Griffith, Matthew Harker, Yvonne Silove, Tasneem Hoosain, Nick Wilson, Ronnie Moodley, Richard Fluck, Chris Gush, David Wheeler, Liam Smeeth, Ron Cullen, Andy Syme, Richard Gunn, Paul Wright, Hugh Gallagher, Sion Edwards, Fiona Loud, Nick Palmer, Richard Fluck, Anita Sharma, Kate Cheema, Andy Syme, Sally Hull, Ben Caplin, Lois Kim, and Faye Cleary from the NCKDA steering, clinical reference, and statistical groups. Funding Information: This work was supported by Kidney Research UK (grant number IN_008_20180304) and the Health Foundation (grant number 1725841). JS is a Doctoral Research Fellow funded by the NIHR (NIHR 300906). DA is funded by a joint research grant from the British Heart Foundation (SP/16/5/32415) and Cancer Research UK (C53325/A21134). Publisher Copyright: © 2023, The Author(s).

PY - 2023/11/2

Y1 - 2023/11/2

N2 - BACKGROUND: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK.METHODS: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017.RESULTS: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people.CONCLUSIONS: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.

AB - BACKGROUND: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK.METHODS: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017.RESULTS: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people.CONCLUSIONS: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.

KW - Humans

KW - ST Elevation Myocardial Infarction/epidemiology

KW - Treatment Outcome

KW - Risk Factors

KW - Myocardial Infarction/epidemiology

KW - Renal Insufficiency/complications

KW - Kidney

KW - Percutaneous Coronary Intervention

U2 - 10.1186/s12882-023-03377-x

DO - 10.1186/s12882-023-03377-x

M3 - Article (Academic Journal)

C2 - 37919679

SN - 1471-2369

VL - 24

SP - 325

JO - BMC Nephrology

JF - BMC Nephrology

IS - 1

M1 - 325

ER -

Management and outcomes of myocardial infarction in people with impaired kidney function in England

Abstract

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