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

Wang, Tracy Y

Vora, Amit N

Peng, S Andrew

Fonarow, Gregg C

Das, Sandeep

de Lemos, James A

Peterson, Eric D

England

2017-07-06T16:03:21Z

2017-07-06T16:03:21Z

2016-01-21

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.

https://www.ncbi.nlm.nih.gov/pubmed/26796254

JAHA.115.002612

2047-9980

https://hdl.handle.net/10161/15023

eng

Ovid Technologies (Wolters Kluwer Health)

J Am Heart Assoc

10.1161/JAHA.115.002612

aldosterone antagonist therapy

heart failure

mortality

older population

Acute Kidney Injury

Age Factors

Aged

Aged, 80 and over

Databases, Factual

Drug Prescriptions

Drug Utilization Review

Female

Heart Failure

Humans

Hyperkalemia

Male

Medicare

Mineralocorticoid Receptor Antagonists

Myocardial Infarction

Practice Patterns, Physicians'

Registries

Risk Assessment

Risk Factors

Spironolactone

Stroke Volume

Time Factors

Treatment Outcome

United States

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

Journal article

Peterson, Eric D|0000-0002-5415-4721

https://www.ncbi.nlm.nih.gov/pubmed/26796254

1

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

School of Medicine

Published online

5