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Incidence of and Risk Factors for Severe Adverse Events in Elderly Patients Taking Angiotensin‐Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers after an Acute Myocardial Infarction
Author(s) -
Fang Gang,
Annis Izabela E.,
Farley Joel F.,
Mahendraratnam Nirosha,
Hickson Ryan P.,
Stürmer Til,
Robinson Jennifer G.
Publication year - 2018
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2051
Subject(s) - medicine , myocardial infarction , hyperkalemia , cumulative incidence , kidney disease , incidence (geometry) , retrospective cohort study , discontinuation , adverse effect , cohort , emergency medicine , physics , optics
Study Objective To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin‐converting enzyme inhibitors ( ACEI s) or angiotensin II receptor blockers ( ARB s) after an acute myocardial infarction ( AMI ). Design Retrospective cohort study. Data Sources Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U.S. Census Bureau, and Multum Lexicon Drug database. Patients A total of 101,588 eligible Medicare fee‐for‐service beneficiaries 66 years or older, who were hospitalized for AMI between January 1, 2008, and December 31, 2009, and used ACEI s or ARB s within 30 days after discharge. Measurements and Main Results Primary outcomes were hospitalizations for acute renal failure ( ARF ) and hyperkalemia. The secondary outcome was discontinuation or suspension of ACEI / ARB therapy after a visit to a health care provider. The primary risk factors of interest were age, sex, race/ethnicity, and chronic kidney disease ( CKD ). Cumulative incidence curves and multivariable Fine‐Gray proportional hazards models with 95% confidence intervals ( CI s) were used with death as a competing risk in both intention‐to‐treat ( ITT ) and as‐treated ( AT ) analyses. In the study cohort, 2.8% experienced ARF , 0.5% experienced hyperkalemia, and 63.7% discontinued ACEI / ARB therapy within 1 year after hospital discharge. Approximately half of the incidence of ARF and hyperkalemia occurred within 6 months after hospital discharge, but the cumulative incidence increased after 6 months. Patients older than 85 years had a higher rate of ARF ( ITT hazard ratio [ HR ] 1.15, 95% CI 1.04–1.28) and hyperkalemia ( ITT HR 1.33, 95% CI 1.05–1.68) compared with those aged 65–74 years. Patients with baseline CKD had higher rates of ARF ( ITT HR 1.61, 95% CI 1.42–1.82), hyperkalemia ( ITT HR 1.41, 95% CI 1.11–1.77), and ACEI / ARB therapy discontinuation or suspension ( ITT HR 1.05, 95% CI 1.02–1.09). Conclusion We found a low incidence of ARF and hyperkalemia in elderly patients treated with ACEI s or ARB s after AMI hospitalization. However, a high rate of treatment discontinuation might prevent a higher rate of occurrence of these events. Long‐term careful monitoring of severe adverse events and timely discontinuation of ACEI s or ARB s among elderly patients with advancing age and CKD after an AMI is warranted in clinical practice.