Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right?
BackgroundOur objective is to estimate the effects associated with higher rates of renin‐angiotensin system antagonists, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs), in secondary prevention for geriatric (aged >65 years) patients with new ischemic stroke...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-06-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009137 |
| _version_ | 1819182704817602560 |
|---|---|
| author | John M. Brooks Cole G. Chapman Manish Suneja Mary C. Schroeder Michelle A. Fravel Kathleen M. Schneider June Wilwert Yi‐Jhen Li Elizabeth A. Chrischilles Douglas W. Brenton Marian Brenton Jennifer Robinson |
| author_facet | John M. Brooks Cole G. Chapman Manish Suneja Mary C. Schroeder Michelle A. Fravel Kathleen M. Schneider June Wilwert Yi‐Jhen Li Elizabeth A. Chrischilles Douglas W. Brenton Marian Brenton Jennifer Robinson |
| author_sort | John M. Brooks |
| collection | DOAJ |
| description | BackgroundOur objective is to estimate the effects associated with higher rates of renin‐angiotensin system antagonists, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs), in secondary prevention for geriatric (aged >65 years) patients with new ischemic strokes by chronic kidney disease (CKD) status. Methods and ResultsThe effects of ACEI/ARBs on survival and renal risk were estimated by CKD status using an instrumental variable (IV) estimator. Instruments were based on local area variation in ACEI/ARB use. Data abstracted from charts were used to assess the assumptions underlying the instrumental estimator. ACEI/ARBs were used after stroke by 45.9% and 45.2% of CKD and non‐CKD patients, respectively. ACEI/ARB rate differences across local areas grouped by practice styles were nearly identical for CKD and non‐CKD patients. Higher ACEI/ARB use rates for non‐CKD patients were associated with higher 2‐year survival rates, whereas higher ACEI/ARB use rates for patients with CKD were associated with lower 2‐year survival rates. While the negative survival estimates for patients with CKD were not statistically different from zero, they were statistically lower than the estimates for non‐CKD patients. Confounders abstracted from charts were not associated with the instrumental variable used. ConclusionsHigher ACEI/ARB use rates had different survival implications for older ischemic stroke patients with and without CKD. ACEI/ARBs appear underused in ischemic stroke patients without CKD as higher use rates were associated with higher 2‐year survival rates. This conclusion is not generalizable to the ischemic stroke patients with CKD, as higher ACEI/ARBS use rates were associated with lower 2‐year survival rates that were statistically lower than the estimates for non‐CKD patients. |
| first_indexed | 2024-12-22T22:50:22Z |
| format | Article |
| id | doaj.art-27f62adab46841e9a1b1ded70f800be0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:50:22Z |
| publishDate | 2018-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-27f62adab46841e9a1b1ded70f800be02022-12-21T18:09:59ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-06-0171110.1161/JAHA.118.009137Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right?John M. Brooks0Cole G. Chapman1Manish Suneja2Mary C. Schroeder3Michelle A. Fravel4Kathleen M. Schneider5June Wilwert6Yi‐Jhen Li7Elizabeth A. Chrischilles8Douglas W. Brenton9Marian Brenton10Jennifer Robinson11Arnold School of Public Health, University of South Carolina, Columbia, SCArnold School of Public Health, University of South Carolina, Columbia, SCUniversity of Iowa Hospitals and Clinics, Iowa City, IAUniversity of Iowa College of Pharmacy, Iowa City, IAUniversity of Iowa College of Pharmacy, Iowa City, IASchneider Research Associates, Des Moines, IASchneider Research Associates, Des Moines, IAArnold School of Public Health, University of South Carolina, Columbia, SCUniversity of Iowa College of Public Health, Iowa City, IASchneider Research Associates, Des Moines, IASchneider Research Associates, Des Moines, IAUniversity of Iowa College of Public Health, Iowa City, IABackgroundOur objective is to estimate the effects associated with higher rates of renin‐angiotensin system antagonists, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs), in secondary prevention for geriatric (aged >65 years) patients with new ischemic strokes by chronic kidney disease (CKD) status. Methods and ResultsThe effects of ACEI/ARBs on survival and renal risk were estimated by CKD status using an instrumental variable (IV) estimator. Instruments were based on local area variation in ACEI/ARB use. Data abstracted from charts were used to assess the assumptions underlying the instrumental estimator. ACEI/ARBs were used after stroke by 45.9% and 45.2% of CKD and non‐CKD patients, respectively. ACEI/ARB rate differences across local areas grouped by practice styles were nearly identical for CKD and non‐CKD patients. Higher ACEI/ARB use rates for non‐CKD patients were associated with higher 2‐year survival rates, whereas higher ACEI/ARB use rates for patients with CKD were associated with lower 2‐year survival rates. While the negative survival estimates for patients with CKD were not statistically different from zero, they were statistically lower than the estimates for non‐CKD patients. Confounders abstracted from charts were not associated with the instrumental variable used. ConclusionsHigher ACEI/ARB use rates had different survival implications for older ischemic stroke patients with and without CKD. ACEI/ARBs appear underused in ischemic stroke patients without CKD as higher use rates were associated with higher 2‐year survival rates. This conclusion is not generalizable to the ischemic stroke patients with CKD, as higher ACEI/ARBS use rates were associated with lower 2‐year survival rates that were statistically lower than the estimates for non‐CKD patients.https://www.ahajournals.org/doi/10.1161/JAHA.118.009137angiotensin receptorchronic kidney diseaseinstrumental variablesischemic strokerenin angiotensin systemsecondary prevention |
| spellingShingle | John M. Brooks Cole G. Chapman Manish Suneja Mary C. Schroeder Michelle A. Fravel Kathleen M. Schneider June Wilwert Yi‐Jhen Li Elizabeth A. Chrischilles Douglas W. Brenton Marian Brenton Jennifer Robinson Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiotensin receptor chronic kidney disease instrumental variables ischemic stroke renin angiotensin system secondary prevention |
| title | Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? |
| title_full | Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? |
| title_fullStr | Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? |
| title_full_unstemmed | Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? |
| title_short | Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right? |
| title_sort | use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers for geriatric ischemic stroke patients are the rates right |
| topic | angiotensin receptor chronic kidney disease instrumental variables ischemic stroke renin angiotensin system secondary prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009137 |
| work_keys_str_mv | AT johnmbrooks useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT colegchapman useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT manishsuneja useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT marycschroeder useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT michelleafravel useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT kathleenmschneider useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT junewilwert useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT yijhenli useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT elizabethachrischilles useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT douglaswbrenton useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT marianbrenton useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright AT jenniferrobinson useofangiotensinconvertingenzymeinhibitorsandangiotensinreceptorblockersforgeriatricischemicstrokepatientsaretheratesright |