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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).

Publication ,  Journal Article
Rao, KK; Enriquez, JR; de Lemos, JA; Alexander, KP; Chen, AY; McGuire, DK; Fonarow, GC; Das, SR
Published in: Am Heart J
October 2013

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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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2013

Volume

166

Issue

4

Start / End Page

709 / 715

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Patient Discharge
  • Myocardial Infarction
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
 

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Rao, K. K., Enriquez, J. R., de Lemos, J. A., Alexander, K. P., Chen, A. Y., McGuire, D. K., … Das, S. R. (2013). 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). Am Heart J, 166(4), 709–715. https://doi.org/10.1016/j.ahj.2013.06.020
Rao, Krishnasree K., Jonathan R. Enriquez, James A. de Lemos, Karen P. Alexander, Anita Y. Chen, Darren K. McGuire, Gregg C. Fonarow, and Sandeep R. Das. “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).Am Heart J 166, no. 4 (October 2013): 709–15. https://doi.org/10.1016/j.ahj.2013.06.020.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2013

Volume

166

Issue

4

Start / End Page

709 / 715

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Patient Discharge
  • Myocardial Infarction
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged