Abstract 2947: Evolving Patterns of Use of Aldosterone Inhibition in Chronic Heart Failure; A Report from Get with the Guidelines HF
Aldosterone inhibition (ALD-I) is recommended in pts with moderately severe to severe HF (i.e. hospitalized for HF) and reduced LVEF with serum creatinine [S.Cr] < 2.5 mg/dL- men/< 2.0 mg/dL - women, and serum potassium [K+] < 5.0 mEq/L. Prior studies suggested both under utilization of ALD-I and a potential for harm. It is unknown how often HF pts in a quality of care hospital program are administered ALD-I per recommendations. In the Get With The Guidelines (GWTG) HF, a collaborative quality improvement program for hospitalized HF pts, data were recorded on 45,322 HF pts from 242 hospitals discharged home from 1/05–12/07. Cochran-Mantel-Haenszel general association and row mean score statistics were used to test association between ALD-I use and pt groups and ALD-I use and time, respectively. Within-hospital clustering was considered. Mean age was 70 ± 14.4 yrs, mean EF was 38% ± 17, and 51.5% were male. Overall ALD-I use was 18.9%; use per recommendations in pts with LVSD and reduced LVEF (EF </= 35%) was 34%. ALD-I use increased over time in general (P < 0.0001) and based on recommended criteria (all P </= 0.001; Table⇓). Of ALD-I users, over 99% had recommended levels of K+ and over 95% had recommended levels of S.Cr. Compliance in using ALD-I based on renal function and K+ remained constant over time (Table⇓) and use in pts with S.Cr >/= 2.5 mg/dL and K+ > 5.5 mEq/L was minimal. After controlling for multivariable pt characteristics in a subset of 13,289 pts with LVSD (67% of the LVSD population), ALD-I use was most associated with S.Cr < 2.5 (OR 2.22; 95% CI 1.8, 2.7; P < .0001) and use of other evidence based HF therapies (OR 2.35; 95% CI, 1.6, 3.4; P < .0001). Within pts in GWTG HF, appropriate use of ALD-I increased from 2005–2007 while non-indicated use was low. However, use of ALD-I remains only one third of eligible patients. Additional research is required to identify ongoing impediments to use of this therapy.
This research has received full or partial funding support from the American Heart Association, AHA National Center.