PMID- 32983725
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 8
DP  - 2020 Aug 25
TI  - The Utilization of Spironolactone in Heart Failure Patients at a Tertiary 
      Hospital in Saudi Arabia.
PG  - e10032
LID - 10.7759/cureus.10032 [doi]
LID - e10032
AB  - INTRODUCTION: Heart failure (HF) has high morbidity and mortality rates. 
      Spironolactone has shown a 30% reduction in all-cause mortality, reduction in 
      hospitalizations, and sudden death. However, data shows low use of spironolactone 
      in HF patients. We aim to assess spironolactone utilization in HF reduced 
      Ejection Fraction (HFrEF) patients and to identify the factors affecting its 
      prescribing. METHODS: A retrospective cross-sectional study of patients diagnosed 
      with HF from January 2016 to January 2017 conducted at King Abdulaziz Medical 
      City-Riyadh. INCLUSION CRITERIA: all adult HFrEF <40% who are eligible for 
      spironolactone with New York Heart Association (NYHA) class II-IV. Serum 
      creatinine should be <2.5 mg/dL in men or <2.0 mg/dL in women, or estimated 
      glomerular filtration rate (eGFR) >30 mL/min/1.73m(2) and potassium <5.0 mEq/L. 
      EXCLUSION CRITERIA: pediatrics, end-stage renal disease, primary aldosteronism, 
      and allergy to spironolactone. RESULTS: We screened around 5000 HF patients, of 
      whom 368 were included. Among 195 patients who were not on spironolactone, 121 
      patients were eligible to use it; however, they did not receive it. One hundred 
      seventy-three patients were on spironolactone, of whom 30 received the drug 
      although they did not meet the eligibility criteria. The mean age of patients on 
      spironolactone was 61+/-14 and the mean age of patients not on spironolactone was 
      66.6+/-15.6. Two hundred seventy-seven patients in the study population were male. 
      Regarding comorbidities, 265 patients were diabetic. As for laboratory findings, 
      the mean potassium for patients on spironolactone was 4.3 mEq/L; the creatinine 
      and eGFR for patients on spironolactone were 82 umol/L (0.9 mg/dl) and 88 
      mL/min/1.73m(2) while those not on spironolactone had higher creatinine at 93 
      umol/L (1 mg/dl) and eGFR 80 mL/min/1.73m(2). Using multivariate regression, we 
      found many factors affecting spironolactone utilization, including EF before 
      spironolactone, serum creatinine, angiotensin-converting enzyme inhibitors 
      (ACEI), angiotensin-II receptor antagonists (ARBs), furosemide, statin, and 
      stroke. CONCLUSIONS: Spironolactone for HFrEF is underutilized. EF before 
      spironolactone, serum creatinine, ACEI, ARBs, furosemide, statin, and stroke 
      significantly affect spironolactone utilization. Further studies are warranted to 
      identify barriers affecting spironolactone utilization in HF patients 
      from prescribers' perspectives.
CI  - Copyright (c) 2020, Alotaibi et al.
FAU - Alotaibi, Abdulmalik S
AU  - Alotaibi AS
AD  - Pharmaceutical Care, King Abdullah International Medical Research Center/King 
      Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - 
      Ministry of National Guard Health Affairs, Riyadh, SAU.
FAU - Alabdan, Numan
AU  - Alabdan N
AD  - Pharmaceutical Care, King Abdullah International Medical Research Center/King 
      Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - 
      Ministry of National Guard Health Affairs, Riyadh, SAU.
FAU - Alotaibi, Abdullah M
AU  - Alotaibi AM
AD  - Medicine, King Abdullah International Medical Research Center/King Saud bin 
      Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry 
      of National Guard Health Affairs, Riyadh, SAU.
FAU - Aljaafary, Haifa
AU  - Aljaafary H
AD  - Pharmaceutical Care, King Abdullah International Medical Research Center/King 
      Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - 
      Ministry of National Guard Health Affairs, Riyadh, SAU.
FAU - Alqahtani, Mohammed
AU  - Alqahtani M
AD  - Medicine, King Abdullah International Medical Research Center/King Saud bin 
      Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry 
      of National Guard Health Affairs, Riyadh, SAU.
LA  - eng
PT  - Journal Article
DEP - 20200825
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7515793
OTO - NOTNLM
OT  - aldosterone antagonists
OT  - heart failure
OT  - mineralocorticoid receptor antagonist
OT  - saudi arabia
OT  - spironolactone utilization
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/09/29 06:00
MHDA- 2020/09/29 06:01
PMCR- 2020/08/25
CRDT- 2020/09/28 05:43
PHST- 2020/09/28 05:43 [entrez]
PHST- 2020/09/29 06:00 [pubmed]
PHST- 2020/09/29 06:01 [medline]
PHST- 2020/08/25 00:00 [pmc-release]
AID - 10.7759/cureus.10032 [doi]
PST - epublish
SO  - Cureus. 2020 Aug 25;12(8):e10032. doi: 10.7759/cureus.10032.