Spironolactone use and higher hospital readmission for Medicare beneficiaries with heart failure, left ventricular ejection fraction <45%, and estimated glomerular filtration rate <45 ml/min/1.73 m(2.).
Although randomized controlled trials have demonstrated benefits of aldosterone antagonists for patients with heart failure and reduced ejection fraction (HFrEF), they excluded patients with serum creatinine >2.5 mg/dl, and their use is contraindicated in those with advanced chronic kidney disease (CKD). In the present analysis, we examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Of the 1,140 patients with HFrEF (EF <45%) and advanced CKD (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m(2)), 207 received discharge prescriptions for spironolactone. Using propensity scores (PSs) for the receipt of discharge prescriptions for spironolactone, we estimated PS-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for spironolactone-associated outcomes. Patients (mean age 76 years, 49% women, 25% African-American) had mean EF 28%, mean eGFR 31 ml/min/1.73 m(2), and mean potassium 4.5 mEq/L. Spironolactone use had significant PS-adjusted association with higher risk of 30-day (HR 1.41, 95% CI 1.04 to 1.90) and 1-year (HR 1.36, 95% CI 1.13 to 1.63) all-cause readmissions. The risk of 1-year all-cause readmission was higher among 106 patients with eGFR <15 ml/min/1.73 m(2) (HR 4.75, 95% CI 1.84 to 12.28) than among those with eGFR 15 to 45 ml/min/1.73 m(2) (HR 1.34, 95% CI 1.11 to 1.61, p for interaction 0.003). Spironolactone use had no association with HF readmission and all-cause mortality. In conclusion, among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all-cause readmission but had no association with all-cause mortality or HF readmission.
University of Iowa, Iowa City, Iowa. Electronic address: chakradhari-inampudi@uiowa.edu.
Chakradhari
C
Inampudi
University of Alabama at Birmingham, Birmingham, Alabama.
Sridivya
S
Parvataneni
University of Alabama at Birmingham, Birmingham, Alabama.
Charity J
CJ
Morgan
University of California, San Francisco, Fresno, California.
Prakash
P
Deedwania
University of California, Los Angeles, California.
Gregg C
GC
Fonarow
University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
Paul W
PW
Sanders
University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
Sumanth D
SD
Prabhu
Emory University, Atlanta, Georgia.
Javed
J
Butler
Harvard University, Boston, Massachusetts.
Daniel E
DE
Forman
New York Medical College, Valhalla, New York.
Wilbert S
WS
Aronow
Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, District of Columbia.
Richard M
RM
Allman
University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
Ali
A
Ahmed
D000368:Aged; D000407:Alabama; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D013148:Spironolactone / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014481:United States
D004232:Diuretics; D013148:Spironolactone