Spironolactone Use and Higher Hospital Readmission for Medicare Beneficiaries With Heart Failure, Left Ventricular Ejection Fraction &lt;45%, and Estimated Glomerular Filtration Rate &lt;45 ml/min/1.73 m2

Inampudi, Chakradhari; Parvataneni, Sridivya; Morgan, Charity J.; Deedwania, Prakash; Fonarow, Gregg C.; Sanders, Paul W.; Prabhu, Sumanth D.; Butler, Javed; Forman, Daniel E.; Aronow, Wilbert S.; Allman, Richard M.; Ahmed, Ali

doi:10.1016/j.amjcard.2014.03.062

Cited by 23 publications

(13 citation statements)

References 16 publications

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“…The incidence of hyperkalemia was significantly higher in the spironolactone group compared to placebo, and the risk was higher among those with worsening kidney function [33]. Impaired kidney function is associated with poor outcomes in HF and spironolactone therapy may further worsen outcome in these patients [34, 35]. Although patients in our study had normal kidney function, a lack of stringent monitoring may have cancelled out a potential clinical benefit during the first 30 days.…”

Section: Discussionmentioning

confidence: 93%

Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

Lam

Dooley

Inampudi

et al. 2017

International Journal of Cardiology

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Background Therapy with evidence-based heart failure (HF) medications has been shown to be associated with lower risk of 30-day all-cause readmission in patients with HF and reduced ejection fraction (HFrEF). Methods We examined the association of aldosterone antagonist use with 30-day all-cause readmission in this population. Of the 2443 Medicare beneficiaries with HF and left ventricular EF ≤35% discharged home from 106 Alabama hospitals during 1998–2001, 2060 were eligible for spironolactone therapy (serum creatinine ≤2.5 for men and ≤2 mg/dl for women, and serum potassium <5 mEq/L). After excluding 186 patients already receiving spironolactone on admission, the inception cohort consisted of 1874 patients eligible for a new discharge prescription for spironolactone, of which 329 received one. Using propensity scores for initiation of spironolactone therapy, we assembled a matched cohort of 324 pairs of patients receiving and not receiving spironolactone balanced on 34 baseline characteristics (mean age 72 years, 42% women, 33% African American). Results 30-day all-cause readmission occurred in 17% and 19% of matched patients receiving and not receiving spironolactone, respectively (hazard ratio {HR}, 0.92; 95% confidence interval {CI}, 0 64 1.32; p=0.650). Spironolactone had no association with 30-day all-cause mortality (HR, 0.84; 95% CI, 0.38–1.88; p=0.678) or HF readmission (HR, 0.74; 95% CI, 0.41 1.31; p=0.301). These associations remained unchanged during 12 months of post-discharge follow-up. Conclusion A discharge prescription for spironolactone had no association with 30-day all-cause readmission among older, hospitalized Medicare beneficiaries with HFrEF eligible for spironolactone therapy.

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Section: Discussionmentioning

confidence: 93%

Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

Lam

Dooley

Inampudi

et al. 2017

International Journal of Cardiology

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“…The studies were mainly conducted in surgical ( n = 14) and cardiac ( n = 11) specialties. Other specialties included geriatrics , pneumology , general internal medicine and intensive care .…”

Section: Resultsmentioning

confidence: 99%

“…The studies were mainly conducted in surgical (n = 14) [34][35][36][37][38][39][40][41][42][43][44][45][46][47] and cardiac (n = 11) [48][49][50][51][52][53][54][55][56][57][58] specialties. Other specialties included geriatrics [59][60][61][62][63][64], pneumology [65][66][67], general internal medicine [68,69] and intensive care [70].…”

Section: Risk Factors For Adverse Health Outcomes After Discharge Fromentioning

confidence: 99%

“…Time to readmission was restricted mostly to 30 days after discharge (n = 15) [39,43,44,48,49,52,54,55,57,60,61,63,65,69,70] but some studies covered longer periods before readmissione.g. 90-day readmission (n = 2) [58,65], and readmission within 1 year (n = 5) [50, 51, 55, 62, 66], 2 years (n = 1) [53] or even 3 years (n = 1) [56], and one study considered readmission without time restrictions [67].…”

Section: Risk Factors For Adverse Health Outcomes After Discharge Fromentioning

confidence: 99%

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Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach

Morath

Mayer

Send

et al. 2017

Brit J Clinical Pharma

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The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.

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“…Based on compelling evidence from these trials, MRAs received Class I recommendations in both American and European guidelines in patients with HF with reduced ejection fraction (HFrEF) . Although considerable variability in MRA use has been reported, most studies indicate that a substantial proportion of eligible HF patients are not taking these drugs . Hospitalization because of exacerbation of HF is common in HFrEF patients and has been identified as a potent risk factor for subsequent morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Mineralocorticoid receptor antagonist use following heart failure hospitalization

et al. 2020

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Aims Patients hospitalized for heart failure (HF) are at increased risk for events post-discharge. Mineralocorticoid receptor antagonists (MRAs) improve the clinical course of patients with HF with reduced ejection fraction. We assessed MRA use in high-risk patients following an HF hospitalization to determine rate of MRA prescription, likelihood of drug continuation post-discharge, reasons for discontinuation, and association between MRA maintenance and outcomes.Methods and results Patients admitted to our hospital system between 2011 and 2013 were identified retrospectively through automated search of electronic medical records for appropriate ICD 9 and 10 codes. Patients with left ventricular ejection fraction <40%, New York Heart Association class III-IV symptoms, >1 year of follow-up and no contraindication to MRA use were included. Of 271 patients meeting inclusion criteria, 105 (38.7%) were prescribed an MRA on discharge from index admission. Over a median follow-up of 3.12 ± 0.09 years, 70 (66.7%) continued MRA therapy, while 35 (33.3%) discontinued MRA therapy. Hyperkalemia, which occurred in 43 of the 105 patients (40.1%), was the most frequent cause of MRA discontinuation. Patients who maintained MRA therapy had significantly less all-cause, cardiovascular, and HF hospitalizations and significantly better survival compared with those who discontinued drug. Conclusions A minority of HF with reduced ejection fraction patients who were eligible for an MRA received them following HF hospitalization and nearly a third of them discontinued drug. Patients who discontinued an MRA were more likely to be hospitalized or die during follow-up. These findings indicate a need for better strategies to increase MRA prescription and maintain therapy following a hospitalization for HF.

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Spironolactone Use and Higher Hospital Readmission for Medicare Beneficiaries With Heart Failure, Left Ventricular Ejection Fraction <45%, and Estimated Glomerular Filtration Rate <45 ml/min/1.73 m2

Cited by 23 publications

References 16 publications

Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach

Mineralocorticoid receptor antagonist use following heart failure hospitalization

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