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Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.ORCID iD: 0000-0002-6785-2895
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.ORCID iD: 0000-0002-5756-7791
2018 (English)In: Cardiovascular therapeutics, ISSN 1755-5914, Vol. 36, no 5, article id e12459Article in journal (Refereed) Published
Abstract [en]

AIM: Previous studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (MRA) in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate why MRA is not used to full extent.

METHODS: A complete community-based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing MRA.

RESULTS: Of 2029 patients, 812 had EF ≤40%. Five hundred and fifty-three patients (68%) tried MRA at some point but 184 of these (33%) discontinued therapy. There were 259 patients that never tried MRA with 177 with a listed explanation or contraindication. Eighty-two patients, 10% of the total HFrEF population, had no clear contraindications. They were older and had less HF hospitalizations compared to patients on MRA (P < 0.05) and 32% did not have any follow-up at the cardiology clinic. Contraindications to MRA were renal dysfunction (93 patients), hypotension (28 patients), and hyperkalemia (25 patients). Only six patients had hyperkalemia without renal dysfunction. Of the patients with renal dysfunction, 66 (72%) had eGFR >30 mL/min.

CONCLUSIONS: The reasons why MRA are underutilized were mainly because of contraindications. However, the data suggest that physicians are overly cautious about moderately reduced kidney function. There seems to be a 10%-18% avoidable undertreatment with MRA, especially for elderly patients that are admitted to the hospital for other reasons than heart failure. This suggests that patients with heart failure would benefit from routine follow-up at a cardiology clinic.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 36, no 5, article id e12459
Keywords [en]
heart failure, heart failure with reduced ejection fraction, mineralocorticoid receptor antagonist, undertreatment
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine; Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-151506DOI: 10.1111/1755-5922.12459ISI: 000444410000008PubMedID: 30019390OAI: oai:DiVA.org:umu-151506DiVA, id: diva2:1245818
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-05-21Bibliographically approved

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Jonsson, AnnaNorberg, HelenaBergdahl, EllinorLindmark, Krister

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