Adrian F. Hernandez|Xiaojuan Mi|Bradley G. Hammill|Stephen C. Hammill|Paul A. Heidenreich|Frederick A. Masoudi|Laura G. Qualls|Eric D. Peterson|Gregg C. Fonarow|Lesley H. Curtis
Associations Between Aldosterone Antagonist Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Reduced Ejection Fraction
Duke University|Clinical Research Institute|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles|Clinical Research Institute|Duke University|Mayo Clinic|VA Palo Alto Health Care System|University of Colorado Anschutz Medical Campus|University of California, Los Angeles
aldosterone antagonist therapy heart failure reduced ejection fraction highly efficacious randomized trials however questions remain regarding effectiveness safety therapy clinical practiceto examine clinical effectiveness newly initiated aldosterone antagonist therapy among older patients hospitalized heart failure reduced ejection fractionusing clinical registry data linked medicare claims 2005 2010 examined outcomes eligible patients hospitalized heart failure reduced ejection fraction used cox proportional hazards models inverseweighted estimates probability treatment adjust treatment selection biasallcause mortality cardiovascular readmission heart failure readmission 3 years hyperkalemia readmission 30 days 1 yearamong 5887 patients met inclusion criteria mean age 776 years 1070 182 started aldosterone antagonist therapy discharge cumulative incidence rates among treated untreated patients 499 vs 512 p 62 mortality 638 vs 639 p 65 cardiovascular readmission 387 vs 449 p 001 heart failure readmission 3 years 29 vs 12 p 001 hyperkalemia readmission within 30 days 89 vs 63 p 002 within 1 year inverse weighting probability treatment significant differences mortality hazard ratio hr 104 95 ci 096114 p 32 cardiovascular readmission hr 100 95 ci 091109 p 94 heart failure readmission lower among treated patients 3 years hr 087 95 ci 077098 p 02 readmission associated hyperkalemia higher aldosterone antagonist therapy 30 days hr 254 95 ci 151429 p 001 1 year hr 150 95 ci 123184 p 001initiation aldosterone antagonist therapy hospital discharge independently associated improved mortality cardiovascular readmission associated improved heart failure readmission among eligible older patients heart failure reduced ejection fraction significant increase risk readmission hyperkalemia predominantly within 30 days discharge