domingo, 16 de diciembre de 2012

Associations between aldosterone antagonist therapy and... [JAMA. 2012] - PubMed - NCBI

Associations between aldosterone antagonist therapy and... [JAMA. 2012] - PubMed - NCBI



New Research on Effectiveness and Safety of Aldosterone Antagonist Therapy in Patients with Heart Failure

Older patients with heart failure and reduced ejection fraction who use aldosterone antagonist therapy after being discharged from the hospital did not experience improved mortality or reduced readmission rates due to cardiovascular conditions, new research from AHRQ’s Effective Health Care Program finds.  However, this therapy was associated with a modest reduction in the risk of hospitalization for heart failure.  Additional research is needed to evaluate the clinical effectiveness of aldosterone antagonists in the broad population of patients with heart failure, the report concludes.  Select to access the abstract, Associations Between Aldosterone Antagonist Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Reduced Ejection Fraction, on PubMed.®

JAMA. 2012 Nov 28;308(20):2097-107. doi: 10.1001/jama.2012.14795.

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

Source

Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina 27715, USA. adrian.hernandez@duke.edu

Abstract

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.
PMID:
23188026
[PubMed - indexed for MEDLINE]

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