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Effectiveness and Safety of Aldosterone Antagonist Therapy Use Among Older Patients With Reduced Ejection Fraction After Acute Myocardial Infarction.

dc.contributor.author Das, S
dc.contributor.author de Lemos, JA
dc.contributor.author Fonarow, GC
dc.contributor.author Peng, SA
dc.contributor.author Peterson, Eric David
dc.contributor.author Vora, Amit Navin
dc.contributor.author Wang, TY
dc.coverage.spatial England
dc.date.accessioned 2017-07-06T16:03:21Z
dc.date.available 2017-07-06T16:03:21Z
dc.date.issued 2016-01-21
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26796254
dc.identifier JAHA.115.002612
dc.identifier.uri http://hdl.handle.net/10161/15023
dc.description.abstract BACKGROUND: While aldosterone antagonists have proven benefit among post-myocardial infarction (MI) patients with low ejection fraction (EF), how this treatment is used among older MI patients in routine practice is not well described. METHODS AND RESULTS: Using ACTION Registry-GWTG linked to Medicare data, we examined 12 080 MI patients ≥65 years with EF ≤40% who were indicated for aldosterone antagonist therapy per current guidelines and without documented contraindications. Of these, 11% (n=1310) were prescribed aldosterone antagonists at discharge. Notably, 10% of patients prescribed an aldosterone antagonist were eligible for, but not concurrently treated with, an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Spironolactone was the predominantly prescribed aldosterone antagonist. At 2-year follow-up, aldosterone antagonist use was not associated with lower mortality (unadjusted 39% versus 38%; HR 0.99, 95% CI 0.88-1.33 using inverse probability-weighted propensity adjustment) except in symptomatic HF patients (HR 0.84, 95% CI 0.72-0.99, Pinteraction=0.009). Risks of hyperkalemia were low at 30 days, but significantly higher among patients prescribed aldosterone antagonists (unadjusted 2.3% versus 1.5%; adjusted HR 2.04, 95% CI 1.16-3.60), as was 2-year risk of acute renal failure (unadjusted 6.7% versus 4.8%; adjusted HR 1.39, 95% CI 1.01-1.92) compared with patients not prescribed aldosterone antagonists. CONCLUSIONS: Aldosterone antagonist use among eligible older MI patients in routine clinical practice was not associated with lower mortality except in patients with HF symptoms, but was associated with increased risks of hyperkalemia and acute renal failure. These results underscore the importance of close post-discharge monitoring of this patient population.
dc.language eng
dc.relation.ispartof J Am Heart Assoc
dc.relation.isversionof 10.1161/JAHA.115.002612
dc.subject aldosterone antagonist therapy
dc.subject heart failure
dc.subject mortality
dc.subject older population
dc.subject Acute Kidney Injury
dc.subject Age Factors
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Databases, Factual
dc.subject Drug Prescriptions
dc.subject Drug Utilization Review
dc.subject Female
dc.subject Heart Failure
dc.subject Humans
dc.subject Hyperkalemia
dc.subject Male
dc.subject Medicare
dc.subject Mineralocorticoid Receptor Antagonists
dc.subject Myocardial Infarction
dc.subject Practice Patterns, Physicians'
dc.subject Registries
dc.subject Risk Assessment
dc.subject Risk Factors
dc.subject Spironolactone
dc.subject Stroke Volume
dc.subject Time Factors
dc.subject Treatment Outcome
dc.subject United States
dc.title Effectiveness and Safety of Aldosterone Antagonist Therapy Use Among Older Patients With Reduced Ejection Fraction After Acute Myocardial Infarction.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26796254
pubs.issue 1
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 5
dc.identifier.eissn 2047-9980


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