Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure
Key result
Inpatient MRA initiation was associated with appropriate follow-up laboratory testing in 25.2% of patients, compared with 2.8% of those initiated as an outpatient.
Why the study?
Does the setting of MRA initiation (inpatient vs outpatient) affect the rates of guideline-indicated laboratory monitoring and adverse events in Medicare beneficiaries with heart failure?
Population
n=10,443 Medicare beneficiaries in 10 US states with prevalent heart failure and incident mineralocorticoid…
Comparison
Mineralocorticoid receptor antagonist initiation vs Inpatient versus outpatient initiation setting…
Design
Cohort
Follow-up
90 days post-initiation
Authors
Discussion
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Implication
May improve MRA monitoring when started inpatient; observational data leaves open whether this should change prescribing practices.
Study Design
Type
Cohort (n=10,443)
Multicenter
Yes
Structured PICO
Does the setting of MRA initiation (inpatient vs outpatient) affect the rates of guideline-indicated laboratory monitoring and adverse events in Medicare beneficiaries with heart failure?
P
Population
10,443 Medicare beneficiaries with prevalent heart failure and incident MRA use, evaluated for follow-up laboratory testing up to 90 days post-initiation.
E
Exposure
Mineralocorticoid receptor antagonist (MRA) initiation
C
Comparator
Inpatient versus outpatient initiation setting; patients with versus without chronic kidney disease
O
Outcome
Laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periodssafety
Main Result
Absolute Event Rate: 25.2% vs 2.8%
Guideline-indicated laboratory monitoring after MRA initiation is extremely poor, particularly in the outpatient setting, highlighting a critical need for quality improvement initiatives to prevent adverse events.
Cite This Study
Cooper et al. (2017) conducted a cohort in Heart failure (n=10,443). Inpatient MRA initiation vs. Outpatient MRA initiation was evaluated on Appropriate follow-up laboratory testing across all time periods. Inpatient MRA initiation was associated with appropriate follow-up laboratory testing in 25.2% of patients, compared with 2.8% of those initiated as an outpatient.