Abstract 17428: Discharge Prescriptions for Spironolactone and 30-day All-cause Readmission in Hospitalized Medicare Beneficiaries With Heart Failure, LVEF Less Than 45% and eGFR Less Than 45
Background: The efficacy of aldosterone antagonists in heart failure and reduced ejection fraction (HFrEF) patients has been established in randomized controlled RALES, EPHESUS and EMPHASIS trials. However, findings from the AHA Get With the Guidelines-Heart Failure based COMPARE-HF (PMID: 23188026) suggest that appropriate patient selection and monitoring may be needed to translate this benefit to clinical effectiveness in the real-world. In the current analysis, we examined if discharge spironolactone use is associated with 30-day all-cause readmission in hospitalized patients with HFrEF and advanced chronic kidney disease (CKD).
Methods: Of the 3067 Medicare beneficiaries, discharged alive from 106 U.S. hospitals (1998-2001) with a primary discharge diagnosis of HF and ejection fraction <45%, 1142 had CKD stage ≥3B, defined as estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 sq.m. Of these, 207 (18% of 1142) received discharge prescriptions for spironolactone. Propensity scores (PS) for spironolactone use were estimated for each of the 1142 patients and used to estimate PS-adjusted hazard ratio (HR) and 95% confidence intervals (CI) for spironolactone-associated outcomes.
Results: Patients (n=1142) had a mean age of 76 years, mean EF of 28%, 49% were women, and 25% were African American. PS-adjusted associations of spironolactone use with post-discharge outcomes are displayed in Table .
Conclusions: Among hospitalized older patients with HFrEF and advanced CKD, a discharge prescription of spironolactone was associated with higher 30-day and longer all-cause readmission and had no association with mortality or HF readmission. Future studies need to examine these associations in more contemporary HFrEF patients and develop strategies to improve patient selection, dosing and monitoring, so that the efficacy of aldosterone antagonists observed in randomized trials may be replicated in real-world patients.
- © 2013 by American Heart Association, Inc.