NYMC Faculty Publications
Lack of Evidence of Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure and Reduced Ejection Fraction Discharged on Spironolactone
DOI
10.1016/j.ijcard.2016.11.006
Journal Title
International Journal of Cardiology
First Page
462
Last Page
466
Document Type
Article
Publication Date
January 2017
Department
Medicine
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. CONCLUSION: 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.
Recommended Citation
Lam, P., Dooley, D., Inampudi, C., Arundel, C., Fonarow, G., Aronow, W. S., Ahmed, A., & Ahmed, A. (2017). Lack of Evidence of Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure and Reduced Ejection Fraction Discharged on Spironolactone. International Journal of Cardiology, 227, 462-466. https://doi.org/10.1016/j.ijcard.2016.11.006
Comments
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