Spironolactone and Outcomes in Older Patients with Heart Failure and Reduced Ejection Fraction

Bayoumi, Essraa; Lam, Phillip H.; Dooley, Daniel J.; Singh, Steven; Faselis, Charles; Morgan, Charity; Patel, Samir S.; Sheriff, Helen; Mohammed, Selma F.; Palant, Carlos E.; Pitt, Bertram; Fonarow, Gregg C.; Ahmed, Ali

doi:10.1016/j.amjmed.2018.09.011

Cited by 23 publications

(18 citation statements)

References 42 publications

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“…This trend of lower adherence to current guidelines in the geriatric population, resulting from poorer renal function, is also confirmed by data from the literature [28,37]. There are encouraging reports of a slight improvement in prognosis in this challenging group of patients taking spironolactone at GFR > 30 ml/ min/1.73m2 [39], which may be an essential therapeutic direction in the future. Our results indicate an interesting trend towards greater use of anticoagulant and antiplatelet therapy in the elderly (Table 4), which is most likely due to both a higher proportion of CAD and atrial fibrillation in this subgroup.…”

Section: Comparison Of Post-hospital Recommendations According To the Agementioning

confidence: 55%

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

Dobrowolska¹,

Miękus²,

Świątczak³

et al. 2021

Eur J Trans Clin Med

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Background: Heart failure (HF) is a leading cause of poor outcome. Age is considered one of the most critical risk factors for both the incidence and prognosis of HF. Therefore we aimed to assess the predictors of poor prognosis in HF patients with particular attention to the elderly population. Material and methods: We retrospectively enrolled patients hospitalized due to HF exacerbation during 2016-2017 (203 patients). The end-points were all-cause mortality and emergency rehospitalizations within a two-year follow-up period. A detailed analysis was performed in the subgroups of patients younger and older than 65 years old. Results: 121 (60%) patients experienced the end-points. Age, low systolic blood pressure, NYHA class IV, right ventricle HF symptoms, high C-reactive protein, troponin, NT-proBNP, hyponatremia, catecholamine therapy and mechanical ventilation during hospitalization independently predicted the end-points. The elderly were characterized by a higher incidence of concomitant diseases and HF with moderately reduced or preserved LVEF, worse laboratory parameters and pharmacological treatment, as well as worse prognosis. Conclusion:The prognosis of patients hospitalized due to HF, mainly the elderly, is poor. Simple clinical parameters could be useful in further decision-making regarding the intensification of their treatment.

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Section: Comparison Of Post-hospital Recommendations According To the Agementioning

confidence: 55%

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

Dobrowolska¹,

Miękus²,

Świątczak³

et al. 2021

Eur J Trans Clin Med

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show abstract

“…Similar results have been reported for MRA use, as data from the GWTG-HF registry revealed that spironolactone was less frequently prescribed for HFrEF patients with advanced renal impairment (serum creatinine: 1.5–2.0 mg/dL) than for patients with serum creatinine concentrations of < 1.5 mg/dL 34 . Another report based on the OPTIMIZE-HF registry revealed that MRA use was associated with good clinical outcomes, even among older patients, if their eGFR was > 30 mL/min/1.73 m 2 35 . Ferreira et al also evaluated MRA prescription patterns in a sub-analysis of data from RCTs and reported that lower MRA doses were prescribed to patients with chronic kidney disease 36 .…”

Section: Discussionmentioning

confidence: 99%

Potential association with malnutrition and allocation of combination medical therapies in hospitalized heart failure patients with reduced ejection fraction

Kawakubo

Kohsaka

Kohno

et al. 2022

Sci Rep

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Malnutrition is common in patients with heart failure with reduced ejection fraction (HFrEF) and may influence the long-term prognosis and allocation of combination medical therapy. We reviewed 1231 consecutive patient-level records from a multicenter Japanese registry of hospitalized HFrEF patients. Nutritional status was assessed using geriatric nutritional risk index (GNRI). Combination medical therapy were categorized based on the use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists. The composite outcome of all-cause death and HF rehospitalization was assessed. The mean age was 72.0 ± 14.2 years and 42.6% patients were malnourished (GNRI < 92). At discharge, 43.6% and 33.4% of patients were receiving two and three agents, respectively. Malnourished patients had lower rates of combination medical therapy use. The standardized GNRI score was independently associated with the occurrence of adverse events (hazard ratio [HR]: 0.88, 95% confidence interval [CI] 0.79–0.98). Regardless of the GNRI score, referenced to patients receiving single agent, risk of adverse events were lower with those receiving three (HR: 0.70, 95% CI 0.55–0.91) or two agents (HR: 0.70, 95% CI 0.56–0.89). Malnutrition assessed by GNRI score predicts long-term adverse outcomes among hospitalized HFrEF patients. However, its prognosis may be modified with combination medical therapy.

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“…Furthermore, in findings from BIOSTAT-CHF, a European multicenter, prospective observational study, only 56% of eligible patients received AA at baseline which improved to 63% after following up with patients as part of an HF treatment optimization program [ 23 ]. Also, in the Medicare-linked Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure (OPTIMIZE-HF) registry, 6986 from 8206 patients had eligibility to use spironolactone based on serum creatinine; however, they were not on it [ 24 ]. Additionally, in the Swedish Heart Failure Registry (SwedeHF) 11,215 patients, only 4443 (40%) of eligible patients received an AA, and to find factors associated with underutilization of AA where creatinine was found to be significantly associated with low-use (although within an acceptable range) while serum potassium was not significant [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The Utilization of Spironolactone in Heart Failure Patients at a Tertiary Hospital in Saudi Arabia

Alotaibi¹,

Alabdan²,

Alotaibi³

et al. 2020

Cureus

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Introduction: Heart failure (HF) has high morbidity and mortality rates. Spironolactone has shown a 30% reduction in all-cause mortality, reduction in hospitalizations, and sudden death. However, data shows low use of spironolactone in HF patients. We aim to assess spironolactone utilization in HF reduced Ejection Fraction (HFrEF) patients and to identify the factors affecting its prescribing. Methods: A retrospective cross-sectional study of patients diagnosed with HF from January 2016 to January 2017 conducted at King Abdulaziz Medical City-Riyadh. Inclusion criteria: all adult HFrEF <40% who are eligible for spironolactone with New York Heart Association (NYHA) class II-IV. Serum creatinine should be <2.5 mg/dL in men or <2.0 mg/dL in women, or estimated glomerular filtration rate (eGFR) >30 mL/min/1.73m 2 and potassium <5.0 mEq/L. Exclusion criteria: pediatrics, end-stage renal disease, primary aldosteronism, and allergy to spironolactone. Results: We screened around 5000 HF patients, of whom 368 were included. Among 195 patients who were not on spironolactone, 121 patients were eligible to use it; however, they did not receive it. One hundred seventy-three patients were on spironolactone, of whom 30 received the drug although they did not meet the eligibility criteria. The mean age of patients on spironolactone was 61±14 and the mean age of patients not on spironolactone was 66.6±15.6. Two hundred seventy-seven patients in the study population were male. Regarding comorbidities, 265 patients were diabetic. As for laboratory findings, the mean potassium for patients on spironolactone was 4.3 mEq/L; the creatinine and eGFR for patients on spironolactone were 82 umol/L (0.9 mg/dl) and 88 mL/min/1.73m 2 while those not on spironolactone had higher creatinine at 93 umol/L (1 mg/dl) and eGFR 80 mL/min/1.73m 2 . Using multivariate regression, we found many factors affecting spironolactone utilization, including EF before spironolactone, serum creatinine, angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II receptor antagonists (ARBs), furosemide, statin, and stroke. Conclusions: Spironolactone for HFrEF is underutilized. EF before spironolactone, serum creatinine, ACEI, ARBs, furosemide, statin, and stroke significantly affect spironolactone utilization. Further studies are warranted to identify barriers affecting spironolactone utilization in HF patients from prescribers' perspectives.

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Spironolactone and Outcomes in Older Patients with Heart Failure and Reduced Ejection Fraction

Abstract: These findings provide evidence of consistent, albeit modest, clinical effectiveness of spironolactone in older patients with HFrEF regardless of renal eligibility criteria used. Additional strategies are needed to improve the effectiveness of aldosterone antagonists in clinical practice.

Cited by 23 publications

References 42 publications

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

Potential association with malnutrition and allocation of combination medical therapies in hospitalized heart failure patients with reduced ejection fraction

The Utilization of Spironolactone in Heart Failure Patients at a Tertiary Hospital in Saudi Arabia

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