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Aldosterone Antagonists May Be Underused in Heart Failure

Cleveland Clinic study finds medication use in only 32.5 percent of patients eligible under guidelines

TUESDAY, Oct. 20 (HealthDay News) -- Many heart failure patients are not receiving aldosterone antagonist therapy, though they may be candidates for it under professional prescribing guidelines, according to a study in the Oct. 21 issue of the Journal of the American Medical Association.

Nancy M. Albert, Ph.D., a registered nurse at the Cleveland Clinic, and colleagues conducted an analysis of 43,625 heart failure patients treated at 241 hospitals participating in the "Get with the Guidelines-Heart Failure" quality improvement initiative from 2005 through 2007. The main outcome was prescription and predictors of aldosterone antagonists use in accordance with American College of Cardiology/American Heart Association (ACC/AHA) guidelines.

Of the 12,565 heart failure patients eligible for aldosterone antagonist therapy under the ACC/AHA guidelines, the researchers note that only 32.5 percent received the medication when they left the hospital. There was wide variance in hospital use of aldosterone antagonist ranging from 0 to 90.6 percent. Use of aldosterone antagonist within guidelines was associated with implantable cardioverter-defibrillator use, pacemaker implantation, younger age, being African-American, lower systolic blood pressure, depression, alcohol use, and no history of renal insufficiency. The inappropriate use of aldosterone antagonist therapy was found to be low.

"Given the substantial morbidity and mortality risk faced by patients hospitalized with heart failure and the established efficacy of aldosterone antagonist prescription in heart failure, a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted," the authors write.

Several study authors reported financial relationships with pharmaceutical companies and the AHA Get With The Guidelines Steering Committee. The Get With The Guidelines program received support from GlaxoSmithKline and Medtronic.

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