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Missed opportunities: low use of evidence-based treatment with eplerenone after myocardial infarction - a nationwide study
- Source :
- Berger, S M S, Schou, M, Schmiegelow, M D, Nume, A K, Christensen, S, Koeber, L, Torp-Pedersen, C & Gislason, G 2013, ' Missed opportunities : low use of evidence-based treatment with eplerenone after myocardial infarction : a nationwide study ', European Heart Journal, vol. 34, no. Suppl. 1, No. 809, pp. 162 . < http://eurheartj.oxfordjournals.org/content/34/suppl_1/809 >
- Publication Year :
- 2013
- Publisher :
- Oxford University Press (OUP), 2013.
-
Abstract
- Purpose: The aldosterone antagonist eplerenone reduces mortality and readmissions after acute myocardial infarction (MI) in patients with LVEF≤40% and either symptomatic heart failure or diabetes mellitus, and is recommended by ESC guidelines. We investigated evidence-based use of eplerenone in a nationwide cohort of patients after first-time MI in Denmark. Methods: From national registers we included all patients with MI, aged ≥30 years and surviving ≥30 days. Indication for eplerenone was defined as claimed prescription of loop-diuretics in addition to either ACE-inhibitor or antidiabetic drugs, within 90 days after discharge. Use of eplerenone and other aldosterone antagonists was identified, and survival compared by Kaplan-Meier analysis. Results: We included 49,479 patients (63% men, mean age 68.1±13.6 years) with a median follow-up of 1003 (IQR 420-1716) days. Treatment with eplerenone was indicated in 9,115 (18.4%) patients, of which 93 (1.02%) received eplerenone, and 2,157 (23.7%) received spironolactone. Mortality rates for groups with and without indication for eplerenone at one-year were 1,096 (16.0%) and 3,115 (8.1%), and at end of follow-up 2,871 (41.8%) and 8,680 (22.5%), respectively (Figure). Applying the evidence-based mortality reducing effect of eplerenone to our results, a potential of 164 and 431 deaths within the first year, and during long-term follow-up, respectively, could have been saved by guideline-recommended use of eplerenone. ![Figure][1] Survival by eplerenone indication Conclusions: In a nationwide cohort of post-MI patients, a low use of eplerenone was observed in patients with indication for treatment. Our findings suggest an unexploited potential in the treatment of high-risk group of patients, and therefore focus on initiation of evidence-based treatment is warranted. [1]: pending:yes
- Subjects :
- medicine.medical_specialty
Aldosterone
business.industry
Mortality rate
medicine.disease
Eplerenone
chemistry.chemical_compound
chemistry
Internal medicine
Diabetes mellitus
Heart failure
Cohort
medicine
Cardiology
Spironolactone
Myocardial infarction
Cardiology and Cardiovascular Medicine
business
medicine.drug
Subjects
Details
- ISSN :
- 15229645 and 0195668X
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- European Heart Journal
- Accession number :
- edsair.doi.dedup.....0a6359a1e7b27ac843a70627fa12e407