PMID- 29578280
OWN - NLM
STAT- MEDLINE
DCOM- 20190208
LR  - 20240403
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 20
IP  - 9
DP  - 2018 Sep
TI  - Factors associated with underuse of mineralocorticoid receptor antagonists in 
      heart failure with reduced ejection fraction: an analysis of 11 215 patients from 
      the Swedish Heart Failure Registry.
PG  - 1326-1334
LID - 10.1002/ejhf.1182 [doi]
AB  - AIM: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart 
      failure with reduced ejection fraction (HFrEF), but are underutilized. 
      Hyperkalaemia may be one reason, but the underlying reasons for underuse are 
      unknown. The aim of this study was to investigate the independent predictors of 
      MRA underuse in a large and unselected HFrEF cohort. METHODS AND RESULTS: We 
      included patients with HFrEF (ejection fraction <40%), New York Heart Association 
      (NYHA) class II-IV and heart failure (HF) duration >/=6 months from the Swedish HF 
      Registry. Logistic regression analysis identified independent associations 
      between 39 demographic, clinical, co-treatment, and socioeconomic predictors and 
      MRA non-use. Of 11 215 patients, 27% were women; mean age was 75 +/- 11 years; only 
      4443 (40%) patients received MRA. Selected characteristics independently 
      associated with MRA non-use were in descending order of magnitude: lower 
      creatinine clearance (<60 mL/min), no need for diuretics, no cardiac 
      resynchronization therapy/implantable cardioverter-defibrillator, higher blood 
      pressure, no digoxin use, higher ejection fraction, outpatient setting, older 
      age, lower income, ischaemic heart disease, male sex, follow-up in primary vs. 
      specialty care, lower NYHA class, and absence of hypertension diagnosis. Plasma 
      potassium and N-terminal pro B-type natriuretic peptide levels were not 
      associated with MRA non-use. CONCLUSION: Mineralocorticoid receptor antagonists 
      remain underused in HFrEF. Their use does not decrease with elevated potassium 
      but does with impaired renal function, even in the creatinine clearance 30-59.9 
      mL/min range where MRAs are not contraindicated. MRA underuse may be further 
      related to non-specialist care, milder HF and no use of other HF therapy.
CI  - (c) 2018 The Authors. European Journal of Heart Failure (c) 2018 European Society of 
      Cardiology.
FAU - Savarese, Gianluigi
AU  - Savarese G
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, 
      Sweden.
FAU - Carrero, Juan-Jesus
AU  - Carrero JJ
AD  - Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
      Stockholm, Sweden.
FAU - Pitt, Bertram
AU  - Pitt B
AD  - Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
FAU - Anker, Stefan D
AU  - Anker SD
AD  - Division of Cardiology and Metabolism, Department of Cardiology (CVK); and 
      Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for 
      Cardiovascular Research (DZHK) partner site Berlin, Charite Universitatsmedizin 
      Berlin, Germany.
AD  - Department of Cardiology and Pneumology, University Medicine Gottingen (UMG), 
      Gottingen, Germany.
FAU - Rosano, Giuseppe M C
AU  - Rosano GMC
AD  - Cardiovascular and Cell Sciences Research Institute, St George's University, 
      London, UK.
AD  - IRCCS San Raffaele Pisana, Rome, Italy.
FAU - Dahlstrom, Ulf
AU  - Dahlstrom U
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Lund, Lars H
AU  - Lund LH
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, 
      Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20180326
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
CIN - Eur J Heart Fail. 2018 Sep;20(9):1335-1337. PMID: 29851224
MH  - Aged
MH  - Humans
MH  - Follow-Up Studies
MH  - *Heart Failure/drug therapy/epidemiology/physiopathology
MH  - Incidence
MH  - *Medical Errors/statistics & numerical data
MH  - *Mineralocorticoid Receptor Antagonists/administration & dosage
MH  - Prognosis
MH  - *Registries
MH  - Retrospective Studies
MH  - *Risk Assessment
MH  - Risk Factors
MH  - *Stroke Volume/physiology
MH  - Survival Rate/trends
MH  - Sweden/epidemiology
OTO - NOTNLM
OT  - Guidelines
OT  - Heart failure with reduced ejection fraction
OT  - Hyperkalaemia
OT  - Mineralocorticoid receptor antagonists
EDAT- 2018/03/27 06:00
MHDA- 2019/02/09 06:00
CRDT- 2018/03/27 06:00
PHST- 2017/11/24 00:00 [received]
PHST- 2018/02/13 00:00 [revised]
PHST- 2018/02/20 00:00 [accepted]
PHST- 2018/03/27 06:00 [pubmed]
PHST- 2019/02/09 06:00 [medline]
PHST- 2018/03/27 06:00 [entrez]
AID - 10.1002/ejhf.1182 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2018 Sep;20(9):1326-1334. doi: 10.1002/ejhf.1182. Epub 2018 Mar 
      26.