Spironolactone use in patients with heart failure.
BACKGROUND
The addition of spironolactone, an aldosterone antagonist, to standard therapy can reduce the risk of both morbidity and mortality in patients with severe heart failure.


OBJECTIVE
To evaluate the use of spironolactone in class III and IV heart failure patients in four urban teaching hospitals.


METHODS
We conducted a concurrent medical record review of 163 patients with documented heart failure admitted to a general medicine service over a 5-week period. Data retrieved included patient demographics, heart failure class, left ventricular ejection fraction, spironolactone contraindications, spironolactone use, dose and frequency, and other heart failure medication use, dose and frequency. All data reflected patients' baseline status.


RESULTS
Our patient population was 80% white people, 61% male, with a mean age of 70 years (35-99). A total of 114 had class III or IV heart failure (70%). Angiotensin-converting enzyme inhibitors or appropriate alternative were prescribed in 117 (72%) patients, whereas beta-blockers were used in 121 (74%) patients. Fifty-seven patients met spironolactone ideal candidate criteria. Of these, eight (14%) were appropriately prescribed spironolactone.


CONCLUSIONS
Three years after publication of the Randomized Aldactone Evaluation Study, spironolactone is underutilized in the treatment of heart failure. Results of this study indicated that the majority of patients in class III or IV heart failure were not prescribed spironolactone. Improvements in spironolactone prescribing are needed.
Trujillo
J M
JM
Northeastern University School of Pharmacy, Northeastern University, Boston, MA 02115-5000, USA. j.trujillo@neu.edu
Gonyeau
M J
MJ
DiVall
M V
MV
Alexander
S L
SL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003211:Concurrent Review; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000473:pathology; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use*
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone