Epidemiology of Ischemic Heart Disease in Patients with Chronic Kidney Disease in Alberta
Creators: Cooper, Matthew
Publisher: name: University of Alberta Library
Year: 2024

<p>Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Patients with CKD and CVD are often excluded from randomized control trials leading to a paucity of evidence guiding their care. This study leveraged province-wide administrative health data in Alberta to describe the epidemiology of ischemic heart disease (IHD). We examined the temporal trends in the burden of IHD and acute myocardial infarction (AMI) and processes of care in patients with CKD in Alberta.<br>
Methods and Results: Using the Alberta Kidney Disease Network database, we created a cohort of patients (aged 18 years and above) who received a diagnosis of IHD between 2003 and 2019. The number of IHD cases, non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) episodes were determined by standard definitions and frameworks (international classification of diseases (ICD) codes, procedural and physician billing codes). Processes of care was determined by identifying the proportion of patients that received guideline-recommended medications and/or procedures (coronary artery revascularization), and achievement of quality of care markers of (LDL, HbA1c and albuminuria) within the 12 months following a diagnosis of IHD and 6 months following a diagnosis of STEMI or NSTEMI.  Individuals were categorized based on level of kidney function by KDIGO criteria (stage G1/G2 eGFR &gt;60 ml/min/1.73m2, stage G3 eGFR 59 – 30 ml/min/1.73m2, stage G4 eGFR 29 – 15 ml/min/1.73m22 and stage G5 eGFR &lt;15 ml/min/1.73m2.</p>

<p>Results: A total of 522,961 individuals were diagnosed with IHD in Alberta between 2003 and 2019 and were included in our study cohort. These individuals were categorized based on their level of kidney function according to KDIGO criteria. Between 2003 and 2019, there was an increase in the age and sex-standardized prevalence of IHD across all levels of kidney function and a decrease in the annual incidence of STEMI and NSTEMI for most stages of CKD. Within the 12 months following a diagnosis of IHD, patients with an eGFR ≥ 60 ml/min/1.73m² filled relatively fewer prescriptions for ACEi/ARB, statins, and beta blockers than patients with an eGFR &lt; 60 ml/min/1.73m². Within the 6 months following the diagnosis of STEMI and NSTEMI, as eGFR declined, fewer patients received guideline-recommended medications and, in general, fewer patients achieved LDL &lt; 2 mmol/L and urinary ACR &lt; 3 mg/mmol. Additionally, in the 6 months following the diagnosis of STEMI and NSTEMI, fewer patients underwent invasive coronary revascularization as eGFR declined.<br>
Conclusion: Between 2003 and 2019, the prevalence of IHD increased across all stages of CKD, and there was a concomitant decreasing trend in the incidence of acute forms of IHD (STEMI and NSTEMI). This may reflect the increasing longevity of patients with IHD and CKD in Alberta during this period because of improvements in their care. Guideline-based medications were utilized more frequently in patients with CKD and IHD and less frequently in patients with CKD and STEMI or NSTEMI. PCI and CABG performed less frequently in patients with CKD, with their use inversely associated with eGFR. Future studies should better clarify the factors that mediate the association between eGFR and treatment for IHD, STEMI, and NSTEMI, as well as look at clinically important outcomes in patients with CKD.</p>