Mineralocorticoid Receptor Antagonist Utilization in a Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population: A Cross-Sectional Study.

Mineralocorticoid Receptor Antagonist Utilization in a Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population: A Cross-Sectional Study.

Joyner Kayla Rena; Soric Mate Michael; Boyle Jaclyn Ann; Moorman John Michael; Fredrickson Mary Elizabeth; Turosky Jodie Zlotnik; Kleven Casondra Lee

American Journal of Therapeutics

2018

2018-07

BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) improve survival among patients with heart failure with reduced ejection fraction (HFrEF); however, studies have identified low utilization rates. No study has evaluated the prevalence and predictors of MRA prescribing in a nationally representative outpatient cohort. STUDY QUESTION: What is the prevalence and predictors of MRA prescribing among outpatients with HFrEF in the United States? STUDY DESIGN: A national cross-sectional secondary analysis of the National Ambulatory Medical Care Survey from 2007 to 2014 including all office visits for HFrEF in patients aged \textgreater55 years. Office visits involving patients with any history of chronic renal failure and hyperkalemia were excluded. MEASURES AND OUTCOMES: The primary end point was the MRA prescribing rate. Multivariable logistic regression models were created to identify predictors of use. RESULTS: In total, 1259 visits were eligible for inclusion, representing more than 30 million visits when weighted. MRAs were initiated or continued in 11.1% of HFrEF visits (95% confidence interval [CI] 8.8-13.8). In the full model, predictors included diabetes mellitus (OR 2.27; 95% CI 1.12-4.61), Northeast region (OR 0.20; 95% CI 0.05-0.74), and \textgreater/=4 chronic conditions (OR 0.26; 95% CI 0.10-0.71). Among symptomatic patients, predictors included non-Hispanic black patients (OR 4.55; 95% CI 1.81-11.43), patients aged 65-74 years (OR 3.38; 95% CI 1.53-7.44), and office systolic blood pressure \textgreater130 mm Hg (OR 0.31; 95% CI 0.16-0.60). Physician specialty, visit year, patient sex, and payor type were not significant predictors of MRA utilization. CONCLUSIONS: Although significant data support the use of MRA in HFrEF, utilization is lower than previously estimated.

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