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Aldosterone antagonists at discharge failed to improve mortality, CV readmission
Eligible older patients with HF and reduced ejection fraction who initiated aldosterone antagonist therapy at hospital discharge experienced no improvement in mortality or CV readmission, according to study results. However, initiation of therapy was found to modestly reduce the risk for HF hospitalization.
Adrian F. Hernandez, MD, MHS, of Duke Clinical Research Institute, and colleagues examined the clinical effectiveness of aldosterone antagonist therapy and associations with long-term outcomes of older patients discharged from a hospitalization for HF. The primary outcomes measured included all-cause mortality, CV readmission and HF readmission at 3 years, and readmission associated with hyperkelamia at 30 days and 1 year.
Of the 5,887 patients (mean age, 78 years) at 246 hospitals who met the inclusion criteria, 18.2% received a prescription for an aldosterone antagonist at discharge.
Rates of all-cause mortality (49.9% vs. 51.2%; P=.62) and CV readmission (63.8% vs. 63.9%; P=.65) were similar at 3 years between patients who did and did not receive aldosterone antagonists at discharge. Cumulative incidence rates of arrhythmia (5.4% vs. 3.9%) and elective readmission for an arrhythmia control device (6.5% vs. 4.2%) were higher for treated patients. Further analysis revealed no significant differences in mortality and CV readmissions with treatment, according to a press release.
The cumulative incidence of first HF readmission was significantly lower in the group that received aldosterone antagonists at discharge (38.7% vs. 44.9%; P<.001). The treated group had higher hyperkalemia readmission rates at 30 days (2.9% vs. 1.2%; P<.001) and 1 year (8.9% vs. 6.3%; P=.002). However, the researchers said hyperkalemia was rarely the primary diagnosis for these readmissions.
The researchers said one potential explanation for their findings is that aldosterone antagonists have limited effectiveness regarding mortality in real-world settings among older patients.
“One potential reason for limited effectiveness may be a lack of adherence to or persistence with therapy. … Our findings highlight the importance of conducting clinical trials that can be easily generalized to real-world practice and in which the most vulnerable patient groups are well represented.”
Disclosure: Hernandez reports receiving grant funding from Amylin Pharmaceuticals and Johnson & Johnson and honoraria from AstraZeneca, Corthera and Sanofi-Aventis. See the full study for a list of the other researchers’ relevant financial disclosures.