Transcript Document

Evolving Patterns of Use and Appropriateness of
Aldosterone Antagonists in Heart Failure
Nancy M. Albert, PhD, RN; Clyde W. Yancy, MD; Li Liang, PhD; Adrian F.
Hernandez, MD; Eric D. Peterson, MD, MPH, Xin Zhao, MS, Christopher P.
Cannon, MD; Gregg C. Fonarow, MD
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Background
Aldosterone antagonists are recommended
in patients with moderate-to-severe heart
failure (HF) and systolic dysfunction. Prior
studies
suggest
underutilization
of
aldosterone antagonists in eligible patients
as well as overuse in settings where therapy
may be harmful.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Introduction
Data support the use of aldosterone antagonists in heart
failure patients. Aldosterone antagonists are underutilized
in eligible patients. The GWTG Program has been shown to
improve the appropriate use of aldosterone antagonist
therapy in heart failure patients.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Objective
The purpose of the paper was to evaluate whether a
hospital-based quality program such as GWTG improves
the use of aldosterone antagonist therapy in the
appropriate patient population.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Methods
• Observational analysis
• Outcome measures were prescription and predictors of
use of aldosterone antagonists, based on guideline
criteria.
• 43,625 patients admitted with HF and discharged home
from 241 hospitals participating in the Get With The
Guidelines--HF quality improvement registry between
2005-2007.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Results
•
Rates of inappropriate use of aldosterone antagonists are low: 0.5%
use in patients with documented contraindications and 2.7% use in
patients with higher than recommended creatine levels.
•
The data suggest that less than one third of eligible HF patients were
prescribed an aldosterone antagonist.
•
Only 32.5% (4,087 out of 12,565) of eligible HF patients were prescribed
aldosterone antagonist therapy at discharge. Over the study period,
the number of eligible HF patients receiving an aldosterone antagonist
increased from 28% to 34%.
•
The data showed that the following patient populations received
aldosterone antagonist at a higher rate: young patients, African
Americans, those with lower systolic blood pressures, a history of
implantable cardioverter-defibrillator use, depression, alcohol use, and
pacemaker implantation, and those with no history of renal
insufficiency.
•
Increases in aldosterone antagonist usage in eligible patients were
small from 2005-2007 and stayed below 35% while inappropriate
aldosterone antagonist use remained low.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.
Conclusions
•
These data suggest that in the context of a hospitalbased
performance
improvement
program,
aldosterone antagonist therapy can be used according
to guidelines with little inappropriate use.
•
Given the substantial morbidity and mortality risk
faced by patients hospitalized with HF and the
established efficacy of aldosterone antagonist use in
HF, a stronger uptake of aldosterone antagonist
therapy indicated by evidence-based guidelines may
be warranted.
Albert et al. JAMA. 2009;302(15):1658-1665.
© 2010, American Heart Association. All rights reserved.