In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. suppl_1 ( 2012-04)
Abstract:
Objectives: To measure the use of guideline-recommended aldosterone antagonist therapy in eligible patients with post-MI and reduced ejection fraction (EF), temporal trends, and characteristics associated with use. Background: Current guidelines recommend the initiation of aldosterone antagonist therapy post-AMI for those with an EF ≤ 40% with heart failure or diabetes prior to hospital discharge, in the absence of contraindications. We explored the relationship between this Class IA recommendation issued in 2004 (STEMI)/2007 (NSTEMI) and its implementation into practice. Methods: Data from the AHA’s Get with the Guidelines-CAD national database were analyzed for 81,570 post-AMI patients from 219 hospitals between January 1, 2006 and December 29, 2009 of whom 11,255 (13.8%) were eligible for aldosterone antagonist therapy. Results: Among eligible patients, 1023 (9.1%) were prescribed an aldosterone antagonist at discharge. There was wide variation in use among hospitals (0% to 40.0) with no hospital treating even half their eligible patients. Patient and hospital characteristics independently associated with prescription of aldosterone antagonists were history of diabetes, heart failure, or coronary revascularization. Conversely, patients less likely to have an aldosterone antagonist prescribed had a history of renal insufficiency, were smokers, and had higher EF. Larger hospital size was associated with higher aldosterone antagonist use. Prescription of an aldosterone antagonist increased in the study population from 6.0% to 13.4% from January 2006 to December 2009 (p 〈 0.001). Conclusions: Fewer than one in ten post-MI patients eligible for an aldosterone antagonist, were discharged with this Class IA recommended therapy. Although rates of utilization are rising modestly over time, compliance continues to be extremely low. This discrepancy between evidence based therapy and actual prescribing patterns suggests the need for specific targeted performance improvement efforts.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/circoutcomes.5.suppl_1.A227
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2012
detail.hit.zdb_id:
2453882-6
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