Abstract | Aims: Methods and results: Observational study in 2007-2010 HF patients starting MRA therapy in Stockholm, Sweden. Outcomes included potassium and creatinine laboratory testing before MRA initiation and in the early (Days 1-10) and extended (Days 11-90) post-initiation periods. Exclusion criteria considered death/hospitalization within 90 days, and lack of a second MRA dispense. Of 4036 HF patients starting on MRA, 45% were initiated from a hospital, 24% from a primary care centre, and 30% from other private centres. Overall, 89% underwent pre-initiation testing, being more common among hospital (97%) than for primary care (74%) initiations. Only 24% were adequately monitored in all three recommended intervals, being again more frequent following hospital (33%) than private (21%) or primary care (17%) initiations. In multivariable analyses, adequate monitoring was more likely for hospital [odds ratio (OR) 2.85, 95% confidence interval (95% CI) 2.34-3.56] initiations, and for patients with chronic kidney disease (OR 1.79, 95% CI 1.30-2.43) and concomitant use of angiotensin-converting enzyme (OR 1.27, 95% CI 1.05-1.52), angiotensin receptor blockers (OR 1.19, 95% CI 1.01-1.40) or beta-blockers (OR 1.65, 95% CI 1.22-2.26). Age, sex, and prescribing centre explained a small portion of adequate monitoring (c-statistic 0.63). Addition of comorbidities and medications improved prediction marginally (c-statistic 0.65). Conclusion: Although serum potassium and creatinine monitoring before MRA initiation for HF is frequent, rates of post-initiation monitoring remain suboptimal, especially among primary care centres.
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Authors | Erik Nilsson, Pietro De Deco, Marco Trevisan, Rino Bellocco, Bengt Lindholm, Lars H Lund, Josef Coresh, Juan J Carrero |
Journal | European heart journal. Quality of care & clinical outcomes
(Eur Heart J Qual Care Clin Outcomes)
Vol. 4
Issue 4
Pg. 267-273
(10 01 2018)
ISSN: 2058-1742 [Electronic] England |
PMID | 29726982
(Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Biomarkers
- Mineralocorticoid Receptor Antagonists
- Creatinine
- Potassium
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Topics |
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- Creatinine
(blood)
- Disease Progression
- Female
- Follow-Up Studies
- Heart Failure
(blood, drug therapy)
- Humans
- Male
- Middle Aged
- Mineralocorticoid Receptor Antagonists
(therapeutic use)
- Monitoring, Physiologic
(methods)
- Potassium
(blood)
- Retrospective Studies
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