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Underutilization of Aldosterone Antagonists in Heart Failure
Shanise J Patterson1, Anne B Reaves1,2, Elizabeth A Tolley2
1Methodist University Hospital, USA.
Hospital Pharmacy
|December 26, 2017
Summary
Aldosterone antagonists (AAs) are underused in heart failure (HF) treatment, with only 31% of eligible patients receiving this guideline-recommended therapy. Despite underutilization, AA use did not significantly impact 30- or 90-day readmission rates in this study.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Aldosterone antagonists (AAs) are proven to reduce morbidity, mortality, and hospital readmissions in heart failure (HF).
- Current ACCF/AHA guidelines recommend AA use in HF patients with ejection fraction ≤35% unless contraindicated.
- Previous studies indicate significant underuse of AAs in clinical practice.
Purpose of the Study:
- To assess the proportion of HF patients receiving guideline-consistent AA therapy.
- To identify patients receiving AA therapy inconsistently with guidelines.
- To evaluate 30- and 90-day readmission rates associated with AA use.
Main Methods:
- Retrospective chart review of 346 HF admissions at an inner-city academic medical center.
- Data collected from August 2011 to June 2013.
- Analysis of AA discharge prescription and patient readmission data.
Main Results:
- Only 31% of patients received AA therapy consistent with ACCF/AHA guidelines.
- 35% of patients were discharged on an AA; 75.6% of those not on AA had no contraindications.
- No significant difference in 30- or 90-day readmission rates between AA and non-AA groups.
Conclusions:
- Aldosterone antagonists remain underutilized in heart failure management.
- A significant gap exists between guideline recommendations and clinical practice for AA prescription.
- Further research may be needed to understand factors contributing to underuse and its impact on readmissions.
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