TY - JOUR
T1 - Use of aldosterone antagonists at discharge after myocardial infarction
T2 - Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG)
AU - Rao, Krishnasree K.
AU - Enriquez, Jonathan R.
AU - de Lemos, James A
AU - Alexander, Karen P.
AU - Chen, Anita Y.
AU - McGuire, Darren K
AU - Fonarow, Gregg C.
AU - Das, Sandeep R
N1 - Funding Information:
J. de Lemos is a speaker of Astra Zeneca (modest) and a consultant for Janssen (modest). D. McGuire received research support from Astra Zeneca (modest), consulting fees and research support from Boehringer Ingelheim (significant), research support from Bristol Myer Squibb (modest), research support from Daiichi Sankyo (modest), research support from Eli Lilly (modest), consulting fees and research support from Genentech (significant), research support from GlaxoSmithKline (modest), consulting fees and research support from F. Hoffmann LaRoche (significant), consulting fees from Jannsen (significant), consulting fees and research support from Merck (modest); research support from Orexigen Therapeutics (significant), consulting fees from Sanofi Aventis (modest); and consulting fees and research support from Takeda Pharmaceuticals (significant). G. Fonarow received research support from the Agency for Healthcare Research & Quality (significant), research support from the National Institutes of Health (significant), and consulting fees from Novartis (significant). K. Rao, J. Enriquez, K. Alexander, A. Chen, and S. Das had nothing to disclose.
Funding Information:
This research was supported by the ACC Foundation’s NCDR. ACTION Registry-GWTG is an initiative of the ACC Foundation and the AHA, with partnering support from the Society of Chest Pain Centers, the American College of Emergency Physicians, and the Society of Hospital Medicine. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents. The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com .
PY - 2013/10
Y1 - 2013/10
N2 - Background Aldosterone antagonists (AldA) improve survival after myocardial infarction (MI) in patients with left ventricular systolic dysfunction (ejection fraction [EF] <40%) concomitant with either clinical heart failure (HF) or diabetes mellitus (DM). Although current American College of Cardiology/American Heart Association guidelines provide a class I recommendation for AldA therapy in such patients, how US practice reflects these recommendations is unclear. Methods Using data from the National Cardiovascular Data Registry ACTION Registry-GWTG, we describe contemporary discharge AldA prescription patterns among 202,213 patients discharged after acute MI from 526 US sites participating in ACTION Registry-GWTG between January 2007 and March 2011. Results Overall, 10.0% of patients were eligible for AldA without documented contraindication, with only 14.5% of eligible patients receiving AldA at discharge. Among the subset of AldA-eligible patients discharged on otherwise optimal medical therapy (68.9%), AldAs were prescribed to 16.1%. Aldosterone antagonist use was higher in patients with EF <40% and clinical HF with or without DM (17.7% and 16.6%, respectively), compared with patients with EF <40% and DM without clinical HF (7.8%, P <.001 for each). Fewer than 2% of participating centers used AldA in ≥50% of eligible patients. Conclusions Despite clinical outcome evidence and class I guideline recommendations, AldAs are underused in the United States, with only 1 in 7 eligible patients prescribed AldA at discharge after MI. This contrasts with high use of other evidence-based post-MI medications and identifies a specific gap in translation of evidence into clinical practice.
AB - Background Aldosterone antagonists (AldA) improve survival after myocardial infarction (MI) in patients with left ventricular systolic dysfunction (ejection fraction [EF] <40%) concomitant with either clinical heart failure (HF) or diabetes mellitus (DM). Although current American College of Cardiology/American Heart Association guidelines provide a class I recommendation for AldA therapy in such patients, how US practice reflects these recommendations is unclear. Methods Using data from the National Cardiovascular Data Registry ACTION Registry-GWTG, we describe contemporary discharge AldA prescription patterns among 202,213 patients discharged after acute MI from 526 US sites participating in ACTION Registry-GWTG between January 2007 and March 2011. Results Overall, 10.0% of patients were eligible for AldA without documented contraindication, with only 14.5% of eligible patients receiving AldA at discharge. Among the subset of AldA-eligible patients discharged on otherwise optimal medical therapy (68.9%), AldAs were prescribed to 16.1%. Aldosterone antagonist use was higher in patients with EF <40% and clinical HF with or without DM (17.7% and 16.6%, respectively), compared with patients with EF <40% and DM without clinical HF (7.8%, P <.001 for each). Fewer than 2% of participating centers used AldA in ≥50% of eligible patients. Conclusions Despite clinical outcome evidence and class I guideline recommendations, AldAs are underused in the United States, with only 1 in 7 eligible patients prescribed AldA at discharge after MI. This contrasts with high use of other evidence-based post-MI medications and identifies a specific gap in translation of evidence into clinical practice.
UR - http://www.scopus.com/inward/record.url?scp=84885181092&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84885181092&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2013.06.020
DO - 10.1016/j.ahj.2013.06.020
M3 - Article
C2 - 24093851
AN - SCOPUS:84885181092
SN - 0002-8703
VL - 166
SP - 709
EP - 715
JO - American heart journal
JF - American heart journal
IS - 4
ER -