NEW YORK (Reuters Health) – Fewer than one third of patients hospitalized for heart failure are treated with aldosterone antagonists, even if they meet eligibility guidelines and are being cared for in one of hundreds of centers that participate in a national quality improvement program.

That’s according to a new report in the October 21st issue of the Journal of the American Medical Association by Dr. Nancy M. Albert at the Cleveland Clinic and colleagues.

Guidelines issued in 2005 by the American College of Cardiology/American Heart Association state that aldosterone antagonists are class I agents, “useful and recommended” unless the patient has hyperkalemia, an elevated creatinine level, or an allergy to the medication, or is pregnant. Also in 2005, the national Get With The Guidelines – Heart Failure registry was launched to promote adherence to guideline-based recommendations.

Through the end of 2007, 12,565 adults were treated at 241 registry hospitals for new or worsening heart failure that met ACC/AHA guidelines criteria (without contraindications) and discharged home. Registry data showed that 4087 (or 32%) were given a prescription for an aldosterone antagonist upon hospital discharge.

“Use was less than expected on the basis of clinical trial evidence demonstrating substantial reductions in all-cause mortality and all-cause hospitalization,” the investigators observe.

More specifically, they found, “aldosterone antagonist use for appropriate indications is less common among patients who are elderly, white, have a lower systolic blood pressure, do not have an implantable cardioverter-defibrillator or pacemaker, do not have a history of alcohol use or depression, and have a history of renal insufficiency.”

The report indicates that rates of inappropriate use were low: 0.5% in patients with a documented contraindication and 2.7% in patients with a higher than recommended level of creatinine.

From 2005 to 2007, aldosterone antagonist use in eligible patients with heart failure “increased only modestly,” the researchers report.

Based on “the established efficacy of aldosterone antagonist prescription in heart failure,” they conclude, “a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted.”

Reference:
JAMA 2009;302:1658-1665.