Use of aldosterone antagonists at discharge after myocardial infarction: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG)

Krishnasree K. Rao, Jonathan R. Enriquez, James A de Lemos, Karen P. Alexander, Anita Y. Chen, Darren K McGuire, Gregg C. Fonarow, Sandeep R Das

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)709-715
Number of pages7
JournalAmerican Heart Journal
Volume166
Issue number4
DOIs
StatePublished - Oct 2013

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Mineralocorticoid Receptor Antagonists
Registries
Myocardial Infarction
Guidelines
Diabetes Mellitus
Heart Failure
Left Ventricular Dysfunction
Prescriptions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{4b1f55c5b5ad454ca7fb8fd0b0fcfa0a,
title = "Use of aldosterone antagonists at discharge after myocardial infarction: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG)",
abstract = "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.",
author = "Rao, {Krishnasree K.} and Enriquez, {Jonathan R.} and {de Lemos}, {James A} and Alexander, {Karen P.} and Chen, {Anita Y.} and McGuire, {Darren K} and Fonarow, {Gregg C.} and Das, {Sandeep R}",
year = "2013",
month = "10",
doi = "10.1016/j.ahj.2013.06.020",
language = "English (US)",
volume = "166",
pages = "709--715",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

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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

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.

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U2 - 10.1016/j.ahj.2013.06.020

DO - 10.1016/j.ahj.2013.06.020

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JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

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