This article is more than 5 years old. Information may no longer be current.
Most eligible patients not prescribed aldosterone after acute MI
In a recent study published in the Journal of the American College of Cardiology, researchers found that the majority of patients with acute MI who are eligible for treatment with aldosterone antagonists according to current guidelines do not receive aldosterone antagonists at hospital discharge.
According to researchers, the rate of aldosterone antagonist use has increased slightly. “The reason for this discrepancy between guideline-based therapy and actual prescribing patterns is unclear and should be further studied,” they said.
Researchers analyzed data from the American Heart Association’s Get with the Guidelines –Coronary Artery Disease national database. Records for 81,570 post-acute MI patients were examined from 219 hospitals between 2006 and 2009. Researchers determined that of the total number of patients, 13.8% (11,255) were eligible for aldosterone antagonist therapy.
Researchers found that the overall prescribing of aldosterone antagonists increased from 6% to 13.4% during the study period (P<.001). However, among all 11,255 eligible patients, only 1,023 (9.1%) were prescribed an aldosterone antagonist at hospital discharge. Use of aldosterone antagonists varied from 0% to 40% among hospitals.
History of diabetes, HF, coronary revascularization and larger hospital size were independently associated with varied prescribing of aldosterone antagonists. Researchers also found that patients with a history of kidney dysfunction, tobacco abuse and higher ejection fraction were less likely to be prescribed an aldosterone antagonist.
“Our study shows that the majority of eligible patients are not prescribed aldosterone antagonists after acute MI. This highlights one of the largest treatment gaps between evidence-based guidelines and current treatment patterns for patients after acute MI. Despite the increasing trends seen in temporal analysis, aldosterone antagonist use remains extremely low,” the researchers said in the discussion.
Disclosure: The Get With the Guidelines – Coronary Artery Disease program was provided by the AHA and was supported in part by the AHA Pharmaceutical Roundtable and an unrestricted educational grant from Merck. See the study for a full list of researchers’ financial disclosures.