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Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction.

Publication ,  Journal Article
Hernandez, AF; Mi, X; Hammill, BG; Hammill, SC; Heidenreich, PA; Masoudi, FA; Qualls, LG; Peterson, ED; Fonarow, GC; Curtis, LH
Published in: JAMA
November 28, 2012

CONTEXT: Aldosterone antagonist therapy for heart failure and reduced ejection fraction has been highly efficacious in randomized trials. However, questions remain regarding the effectiveness and safety of the therapy in clinical practice. OBJECTIVE: To examine the clinical effectiveness of newly initiated aldosterone antagonist therapy among older patients hospitalized with heart failure and reduced ejection fraction. DESIGN, SETTING, AND PARTICIPANTS: Using clinical registry data linked to Medicare claims from 2005 through 2010, we examined outcomes of eligible patients hospitalized with heart failure and reduced ejection fraction. We used Cox proportional hazards models and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. MAIN OUTCOME MEASURES: All-cause mortality, cardiovascular readmission, and heart failure readmission at 3 years, and hyperkalemia readmission at 30 days and 1 year. RESULTS: Among 5887 patients who met the inclusion criteria, the mean age was 77.6 years; of those 1070 (18.2%) started aldosterone antagonist therapy at discharge. Cumulative incidence rates among treated and untreated patients were 49.9% vs 51.2% (P = .62) for mortality; 63.8% vs 63.9% (P = .65) for cardiovascular readmission; and 38.7% vs 44.9% (P < .001) for heart failure readmission at 3 years; and 2.9% vs 1.2% (P < .001) for hyperkalemia readmission within 30 days and 8.9% vs 6.3% (P = .002) within 1 year. After inverse weighting for the probability of treatment, there were no significant differences in mortality (hazard ratio [HR], 1.04; 95% CI, 0.96-1.14; P = .32) and cardiovascular readmission (HR, 1.00; 95% CI, 0.91-1.09; P = .94). Heart failure readmission was lower among treated patients at 3 years (HR, 0.87; 95% CI, 0.77-0.98; P = .02). Readmission associated with hyperkalemia was higher with aldosterone antagonist therapy at 30 days (HR, 2.54; 95% CI, 1.51-4.29; P < .001) and 1 year (HR, 1.50; 95% CI, 1.23-1.84; P < .001). CONCLUSIONS: Initiation of aldosterone antagonist therapy at hospital discharge was not independently associated with improved mortality or cardiovascular readmission but was associated with improved heart failure readmission among eligible older patients with heart failure and reduced ejection fraction. There was a significant increase in the risk of readmission with hyperkalemia, predominantly within 30 days after discharge.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 28, 2012

Volume

308

Issue

20

Start / End Page

2097 / 2107

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Stroke Volume
  • Risk
  • Registries
  • Patient Readmission
  • Patient Discharge
  • Mineralocorticoid Receptor Antagonists
  • Medicare
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Hernandez, A. F., Mi, X., Hammill, B. G., Hammill, S. C., Heidenreich, P. A., Masoudi, F. A., … Curtis, L. H. (2012). Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA, 308(20), 2097–2107. https://doi.org/10.1001/jama.2012.14795
Hernandez, Adrian F., Xiaojuan Mi, Bradley G. Hammill, Stephen C. Hammill, Paul A. Heidenreich, Frederick A. Masoudi, Laura G. Qualls, Eric D. Peterson, Gregg C. Fonarow, and Lesley H. Curtis. “Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction.JAMA 308, no. 20 (November 28, 2012): 2097–2107. https://doi.org/10.1001/jama.2012.14795.
Hernandez AF, Mi X, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA, et al. Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA. 2012 Nov 28;308(20):2097–107.
Hernandez, Adrian F., et al. “Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction.JAMA, vol. 308, no. 20, Nov. 2012, pp. 2097–107. Pubmed, doi:10.1001/jama.2012.14795.
Hernandez AF, Mi X, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA, Qualls LG, Peterson ED, Fonarow GC, Curtis LH. Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA. 2012 Nov 28;308(20):2097–2107.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 28, 2012

Volume

308

Issue

20

Start / End Page

2097 / 2107

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Stroke Volume
  • Risk
  • Registries
  • Patient Readmission
  • Patient Discharge
  • Mineralocorticoid Receptor Antagonists
  • Medicare
  • Male