Author + information
- Larry A. Allen,
- Susan Shetterly,
- Pamela N. Peterson,
- Jerry H. Gurwitz,
- David H. Smith,
- David W. Brand,
- Diane Fairclough,
- John S. Rumsfeld,
- Frederick A. Masoudi and
- David J. Magid
Mineralocorticoid receptor antagonists (MRA) reduce morbidity and mortality in select patients with heart failure (HF) and reduced left ventricular ejection fraction, but can cause hyperkalemia and acute kidney injury. Thus, clinical practice guidelines recommend measurement of serum chemistries before and within a week after MRA initiation to ensure patient safety. Patterns of monitoring after MRA initiation in clinical practice are not well described. Whether poor monitoring may reduce safety and partially explain the lack of MRA benefit seen in observational studies remains to be determined.
This was a retrospective cohort study of laboratory monitoring patterns among patients with reduced left ventricular ejection fraction and a history of HF hospitalization starting MRA therapy in the ambulatory setting within 3 large integrated health systems between 2005-2008.
In total, 443 patients had an MRA initiated, spironolactone in 99.3% and eplerenone in 0.7%. Median age was 71 years and 36% were female. In the 30 days before MRA initiation, 6% of patients had no evidence of a serum potassium measurement and 5% of patients had no evidence of serum creatinine measurement. In the 7 days after MRA initiation, 46% of patients had no evidence of serum potassium or creatinine measurement; by 30 days, 15.2% remained untested. Age, baseline creatinine, and baseline potassium were not correlated with subsequent testing.
Laboratory monitoring following initiation of MRA frequently does not meet guideline recommendations. Given the known patient safety risks, quality improvement efforts that encourage the use of MRA for HF should also include mechanisms to ensure recommended monitoring occurs.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Novel and Standard Pharmacological Therapies in Heart Failure: Which Treatment for Which Patient
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1221-285
- 2013 American College of Cardiology Foundation