title: Mineralocorticoid receptor antagonist use in eligible patients following acute myocardial infarction: real world data from the Acute Coronary Syndrome Israeli Surveys: 2004-2010.
abstract: BACKGROUND
  Following the EPHESUS trial in 2003, mineralocorticoid receptor antagonist (MRA) therapy received a class I indication for the management of eligible high-risk post-MI patients. Our goal was to examine temporal trends in MRA use in eligible post-myocardial infarction (MI) patients.
  
  
  METHODS
  We investigated temporal trends and factors associated with MRA utilization among eligible patients enrolled in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) 2004-2010.
  
  
  RESULTS
  Among 7696 patients enrolled in the ACSIS surveys from 2004, 955 (12%) were eligible for MRA therapy. In this population, prescription of MRAs at discharge from the index event showed a modest increase from 21% to 25% over the six-year period, whereas utilization of other guideline recommended drugs, including angiotensin converting enzyme inhibitors/receptor blockers and β-blockers was >2-fold higher. Multivariate logistic regression analysis showed that independent predictors of MRA prescription at discharge included a higher degree of left ventricular dysfunction (LVEF ≤30% vs. 31-40%: OR = 2.19; p = 0.02), history of heart failure prior to admission (OR = 1.92; p <0.004), admission Killip≥II (OR = 1.78; p = 0.004), and an anterior location of the index MI (OR = 1.54; p = 0.03). MRA utilization was not associated with an increased risk for adverse events or rehospitalization at 30 days of follow-up.
  
  
  CONCLUSIONS
  In a real world setting, approximately one quarter of eligible post-MI patients are treated with an MRA following the index event, without a significant time-dependent change in this management strategy. MRAs are more likely to be underutilized in eligible lower-risk patients.
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; Heart Institute, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel; Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: Edward.koifman@sheba.health.gov.il.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.forename: Eran
authors.initials: E
authors.lastname: Kopel
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matezky
authors.forename: Goeffrey
authors.initials: G
authors.lastname: Tofler
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys / Q000639:trends*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010351:Patient Discharge / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Acute myocardial infarction; Heart failure; Mineralocorticoid receptor antagonist