Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone

Phillip H. Lam, Daniel J. Dooley, Chakradhari Inampudi, Cherinne Arundel, Gregg C. Fonarow, Javed Butler, Wen Chih Wu, Marc R. Blackman, Markus S. Anker, Prakash Deedwania, Michel White, Sumanth D. Prabhu, Charity J. Morgan, Thomas E. Love, Wilbert S. Aronow, Richard M. Allman, Ali Ahmed

Research output: Contribution to journalArticle

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 ≤ 2 mg/dl for women, and serum potassium < 5 mEq/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 72 years, 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 12 months 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.

Original languageEnglish (US)
Pages (from-to)462-466
Number of pages5
JournalInternational Journal of Cardiology
Volume227
DOIs
StatePublished - Jan 15 2017

Keywords

  • 30-day all-cause readmission
  • Heart failure
  • Medicare beneficiaries
  • Spironolactone

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lam, P. H., Dooley, D. J., Inampudi, C., Arundel, C., Fonarow, G. C., Butler, J., Wu, W. C., Blackman, M. R., Anker, M. S., Deedwania, P., White, M., Prabhu, S. D., Morgan, C. J., Love, T. E., Aronow, W. S., Allman, R. M., & 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