Abstract 8493: Lack of Association between Discharge Prescription of Aldosterone Antagonists and Outcomes in Medicare Beneficiaries with Heart Failure and Preserved Ejection Fraction: A Propensity-Matched Study of the OPTIMIZE-HF
Background: Aldosterone antagonists reduce mortality in systolic heart failure (HF). However, their effect in HF patients with preserved ejection fraction (HF-PEF) remains unclear. Propensity-matched studies can assemble balanced cohorts while remaining blinded to outcomes, and are suitable when RCTs are difficult or unethical. We examined the association of aldosterone antagonist with outcomes in a propensity-matched cohort of older HF-PEF patients.
Methods: Of the 26,376 OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) patients linked to Medicare outcomes data (through Dec 2008), 10429 patients age ≥65 years with HF-PEF (LVEF ≥40%) were discharged alive. Of these, 866 (8.3%) received a discharge prescription for aldosterone antagonists. Propensity scores for aldosterone antagonist use, estimated for each of the 10429 patients, were used to assemble a cohort of 864 pairs of patients receiving and not receiving these drugs who were balanced on 116 baseline characteristics.
Results: Patients (n=1728) had a mean (±SD) age of 80 (±8) years, a mean (±SD) LVEF of 54% (±9%), 63% were women, and 8% African American. During ∼6 years of follow-up, all-cause mortality occurred in 71% and 70% of matched patients receiving and not receiving aldosterone antagonists (hazard ratio, 1.01; 95% CI, 0.90-1.24; p=0.929; Figure). A similar propensity-adjusted association was observed in the 10429 pre-match patients (hazard ratio, 0.99; 95% CI, 0.91-1.08; p=0.800). Aldosterone antagonist use also had no significant association with HF or all-cause hospitalization.
Conclusions: Discharge prescription of aldosterone antagonists had no association with mortality or hospitalization in a propensity-matched balanced cohort of older HF-PEF patients. Whether these results differ from younger RCT-eligible patients will await results of the ongoing TOPCAT trial.
- © 2011 by American Heart Association, Inc.