Use of Aldosterone Antagonists in Heart Failure

Abstract

LINICAL TRIALS HAVE ESTABlished the incremental benefits of aldosterone antagonist therapy in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), 1-3 such that aldosterone antagonists were designated as class I, "useful and recommended," within the American College of Cardiology/American Heart Association (ACC/AHA) Chronic HF Guidelines. 1 Because aldosterone antagonists can cause hyperkalemia, guidelines promote safety by specifying that prior to use, serum creatinine levels should be 2.5 mg/dL or less in men and 2.0 mg/dL or less in women, and serum potassium levels should be less than 5.0 mEq/L. 1 Adoption of aldosterone antagonists in HF has been mixed; early community studies in Canada and the United States found modest uptake but also increased use in individuals with contraindications and increased admissions for hyperkalemia. 4,5 The Get With The Guidelines-HF (GWTG-HF) program is a national quality improvement program designed to promote adherence to guideline-based recommendations. It is unknown whether participation in a hospital-based quality improvement program may lead to greater frequency of use of aldosterone antagonist therapy for appropriate indications as well as lower use in situations of increased risk. Therefore, the purpose of this study was to examine contemporary aldosterone antagonist use among hospitalized patients with HF, temporal trends in use, and appropriateness of use.

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

“…Two previous studies using data from the Get With the Guidelines‐Heart Failure registry examined MRA therapy in heart failure and risks of adverse events 11, 23. Both studies focused on patients with reduced ejection fraction.…”

“…Using data from 2005 through 2007, Albert et al11 likewise found that MRA therapy was markedly underused in appropriate patients, though rates of inappropriate and potentially inappropriate use were low. Patient characteristics associated with MRA therapy have not changed substantially, with age, systolic blood pressure, and presence of an implantable cardioverter‐defibrillator strongly associated with prescription of MRA therapy.…”

Fluid Management Strategies in Heart Failure

“…Disparities are prevalent in the quality of care in heart failure at both the patient [67][68][69] and hospital level. 67,68,70 Nurses must understand medically appropriate care recommendations and advocate for patients during daily rounds with physicians and pharmacy care providers.…”

“…Disparities are prevalent in the quality of care in heart failure at both the patient [67][68][69] and hospital level. 67,68,70 Nurses must understand medically appropriate care recommendations and advocate for patients during daily rounds with physicians and pharmacy care providers. Nurses should participate in quality improvement programs that focus on monitoring the adherence of health care providers' use of heart failure medications chosen on the basis of research evidence and recommendations for use of cardiac devices.…”

A Selective Antagonist of Mineralocorticoid Receptor Eplerenone in Cardiology Practice

“…Согласно статистике в США эти препараты назначаются только 32% больных, для которых они могли бы быть актуальны [4,5]. Кро-ме того, недавние научные исследования, рассматри-ваемые далее, указали на более существенную взаи-мосвязь между гиперальдостеронизмом и сердечно-сосудистой патологией, нежели считалось ранее, что мо-жет увеличить спектр больных, которым могут назна-чаться антагонисты рецепторов альдостерона.…”