Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

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• 作者：Phillip H. Lam^a ; ¹ ; Daniel J. Dooley^a ; ¹ ; Chakradhari Inampudi^b ; ¹ ; Cherinne Arundel^c ; ^d ; Gregg C. Fonarow^e ; Javed Butler^f ; Wen-Chih Wu^g ; ^h ; Marc R. Blackman^a ; ^c ; ^d ; Markus S. Ankerⁱ ; Prakash Deedwania^j ; Michel White^k ; Sumanth D. Prabhu^l ; Charity J. Morgan^l ; Thomas E. Love^m ; Wilbert S. Aronowⁿ ; Richard M. Allman^o ; Ali Ahmed^c ; ^d ; ^{aliahmedmdmph@gmail.com}
• 关键词：Spironolactone ; 30-day all-cause readmission ; Medicare beneficiaries ; Heart failure
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：462-466
• 全文大小：381 K
• 卷排序：227

文摘

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).MethodsWe 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 ≤ 2 mg/dl for women, and serum potassium < 5 mEq/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 72 years, 42% women, 33% African American).ResultsThirty-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 12 months of post-discharge follow-up.ConclusionA discharge prescription for spironolactone had no association with 30-day all-cause readmission among older, hospitalized Medicare beneficiaries with HFrEF eligible for spironolactone therapy.