Abstract 346: Use of Aldosterone Antagonists at Discharge in Eligible Heart Failure Patients With a Comprehensive Heart Failure Program: Trends in Compliance With Get With the Guidelines-Heart Failure

Abstract

Background: Use of aldosterone antagonist (AA) therapy is a class I recommendation in moderate to severe heart failure (HF). Multiple studies have reported the underutilization of AA in eligible patients. We wished to analyze determining factors for this ongoing underutilization using the AHA’s Get With the Guidelines (GWTG) HF database from American Heart Association (AHA). We hypothesized that elevated creatinine is a major barrier to use of AA. Methods: A comprehensive HF program utilizing the GWTG measures was recently established at our institution. Outcome data utilizing the GWTG registry from January 2009 to June 2012 was analyzed. Given ACC/AHA guidelines that creatinine should be < 2.5 mg/dL in men or < 2.0 mg/dL in women, we chose to analyze genders separately. To analyze effect of degree of creatinine elevation on AA therapy at discharge, two subcategories of creatinine levels were analyzed. Creatinine levels above 2.0 mg/dL in women and 2.5 mg/dL in men were excluded, as AAs are contraindicated in these patients. Categorical variables were compared using the chi-square test. Results: Our total compliance rate with AA therapy at discharge during the study period was 26% (149 of 565) for females and 31% (199 of 640) for males. There was no significant decline in compliance when creatinine levels were >1 mg/dL. Additionally, when comparing rates of compliance according to creatinine level across gender, there was no statistically significant difference in the use of AAs (see Table). Conclusion: Overall, AA therapy compliance at discharge at our center, as well as a majority of nationally recognized HF center participating in GWTG-HF registry remains suboptimal, irrespective of gender. This is despite known data that has clearly shown AAs significantly reduce mortality, cardiovascular death, HF hospitalizations and the composite endpoints. In contrast to prior studies, mild creatinine elevation does not seem to be a significant barrier to presciption of AAs. It is possible that other variables such as polypharmacy, hyperkalemia and effects of dual blockade of the renin-angiotensin-aldosterone system and the possibility of endocrine side effects associated with the non-selective AAs may be playing a role. More aggressive and consistent use of AA therapy for HF is warranted.