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.

• Authors: 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
• Journal: American heart journal (Am Heart J) Vol. 166 Issue 4 Pg. 709-15 (Oct 2013) ISSN: 1097-6744 [Electronic] United States
• PMID: 24093851 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © 2013.

Chemical References

• Mineralocorticoid Receptor Antagonists

Topics

• Aged
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Guideline Adherence
• Humans
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Myocardial Infarction (drug therapy, mortality)
• Patient Discharge
• Registries
• Retrospective Studies
• Risk Factors
• Survival Rate (trends)
• Treatment Outcome
• United States (epidemiology)