Are we underusing aldosterone antagonists in congestive heart failure patients?

Originally published in Insidermedicine

Are we underusing aldosterone antagonists in congestive heart failure patients? Less-than one third of eligible patients being discharged from hospital with heart failure are being prescribed guideline-recommended treatment, even though the hospitals are participating in a program aimed at improving compliance with treatment guidelines, according to research published in the latest issue of the Journal of the American Medical Association.

Here is some information about heart failure:

• It is a condition in which the heart is unable to pump enough blood to satisfy the body’s needs

• It can often be treated but not cured

• In eligible patients with heart failure, use of drugs called aldosterone antagonists can improve health and reduce the risk of death

Researchers from the Cleveland Clinic observed the treatment given to over 40,000 patients with heart failure who were discharged from one of 241 hospitals that were participating in the Get With The Guidelines–heart failure quality improvement registry. This registry is designed to improve adherence to treatment guidelines for heart failure.

More than 12,500 of the patients were eligible to receive aldosterone antagonists, based on guidelines, but only 32.5% of these patients actually received them. Eligible patients were more likely to receive this therapy if they were older, African American, or had a higher systolic blood pressure. They were also more likely to receive this treatment if they had a history of depression, kidney problems, or use of a pacemaker or implantable cardioverter defibrillator (ICD). Use of aldosterone antagonists among patients who were inappropriate for this treatment was rare.

Today’s research demonstrates that aldosterone antagonists are being underused in heart failure patients, even among hospitals participating in programs aimed at improving their compliance with treatment guidelines for heart failure.

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  • sonnet

    From the recent history, the recommendations of Beta blockers in heart failure. It is still under used in Egypt. I remember, even till now, some doctors hesitate while prescribing beta blockers in heart failure. I am speaking about my experience in a developing countries. Some does not know the strategy of adding beta blockers. They add large dose in inappropriate NYHA class. Then, patients deteriorate. Theere is lack the knowledge and experience among physicians. The same regards the use of statins in IHD but due to economics mainly. Also, the changes of guidelines in both CPR and Prophylaxis against infective guidelines were not well followed. Mostly due to worldwide controversy to both and lack of some awareness of the details is a factor.

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