title: Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone.
abstract: BACKGROUND
  Therapy with evidence-based heart failure (HF) medications has been shown to be associated with lower risk of 30-day all-cause readmission in patients with HF and reduced ejection fraction (HFrEF).
  
  
  METHODS
  We examined the association of aldosterone antagonist use with 30-day all-cause readmission in this population. Of the 2443 Medicare beneficiaries with HF and left ventricular EF ≤35% discharged home from 106 Alabama hospitals during 1998-2001, 2060 were eligible for spironolactone therapy (serum creatinine ≤2.5 for men and ≤2mg/dl for women, and serum potassium <5mEq/L). After excluding 186 patients already receiving spironolactone on admission, the inception cohort consisted of 1874 patients eligible for a new discharge prescription for spironolactone, of which 329 received one. Using propensity scores for initiation of spironolactone therapy, we assembled a matched cohort of 324 pairs of patients receiving and not receiving spironolactone balanced on 34 baseline characteristics (mean age 72years, 42% women, 33% African American).
  
  
  RESULTS
  Thirty-day all-cause readmission occurred in 17% and 19% of matched patients receiving and not receiving spironolactone, respectively (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.64-1.32; p=0.650). Spironolactone had no association with 30-day all-cause mortality (HR, 0.84; 95% CI, 0.38-1.88; p=0.678) or HF readmission (HR, 0.74; 95% CI, 0.41 1.31; p=0.301). These associations remained unchanged during 12months of post-discharge follow-up.
  
  
  CONCLUSIONS
  A discharge prescription for spironolactone had no association with 30-day all-cause readmission among older, hospitalized Medicare beneficiaries with HFrEF eligible for spironolactone therapy.
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Lam
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Dooley
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Chakradhari
authors.initials: C
authors.lastname: Inampudi
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
authors.forename: Cherinne
authors.initials: C
authors.lastname: Arundel
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Stony Brook University, Stony Brook, NY, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Veterans Affairs Medical Center, Providence, RI, USA; Brown University, Providence, RI, USA.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Blackman
authors.affiliation: Charité Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany.
authors.forename: Markus S
authors.initials: MS
authors.lastname: Anker
authors.affiliation: University of California, San Francisco, Fresno, CA, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: University of Montreal, Montreal, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Sumanth D
authors.initials: SD
authors.lastname: Prabhu
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.affiliation: New York Medical College, Valhalla, NY, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA. Electronic address: aliahmedmdmph@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000407:Alabama; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D006278:Medicare; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010359:Patient Readmission; D012307:Risk Factors; D013148:Spironolactone / Q000627:therapeutic use*; D013318:Stroke Volume; D016896:Treatment Outcome; D014481:United States
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: 30-day all-cause readmission; Heart failure; Medicare beneficiaries; Spironolactone