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Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone.
- Source :
-
International journal of cardiology [Int J Cardiol] 2017 Jan 15; Vol. 227, pp. 462-466. Date of Electronic Publication: 2016 Nov 04. - Publication Year :
- 2017
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Abstract
- Background: Therapy with evidence-based heart failure (HF) medications has been shown to be associated with lower risk of 30-day all-cause readmission in patients with HF and reduced ejection fraction (HFrEF).<br />Methods: We examined the association of aldosterone antagonist use with 30-day all-cause readmission in this population. Of the 2443 Medicare beneficiaries with HF and left ventricular EF ≤35% discharged home from 106 Alabama hospitals during 1998-2001, 2060 were eligible for spironolactone therapy (serum creatinine ≤2.5 for men and ≤2mg/dl for women, and serum potassium <5mEq/L). After excluding 186 patients already receiving spironolactone on admission, the inception cohort consisted of 1874 patients eligible for a new discharge prescription for spironolactone, of which 329 received one. Using propensity scores for initiation of spironolactone therapy, we assembled a matched cohort of 324 pairs of patients receiving and not receiving spironolactone balanced on 34 baseline characteristics (mean age 72years, 42% women, 33% African American).<br />Results: Thirty-day all-cause readmission occurred in 17% and 19% of matched patients receiving and not receiving spironolactone, respectively (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.64-1.32; p=0.650). Spironolactone had no association with 30-day all-cause mortality (HR, 0.84; 95% CI, 0.38-1.88; p=0.678) or HF readmission (HR, 0.74; 95% CI, 0.41 1.31; p=0.301). These associations remained unchanged during 12months of post-discharge follow-up.<br />Conclusion: A discharge prescription for spironolactone had no association with 30-day all-cause readmission among older, hospitalized Medicare beneficiaries with HFrEF eligible for spironolactone therapy.<br />Competing Interests: Disclosures: None<br /> (Published by Elsevier Ireland Ltd.)
- Subjects :
- Alabama
Female
Heart Failure mortality
Heart Failure physiopathology
Humans
Insurance Benefits
Male
Medicare
Risk Factors
Stroke Volume
Treatment Outcome
United States
Heart Failure drug therapy
Mineralocorticoid Receptor Antagonists therapeutic use
Patient Readmission
Spironolactone therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 227
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27866868
- Full Text :
- https://doi.org/10.1016/j.ijcard.2016.11.006