Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF

João Pedro Ferreira, Patrick Rossignol, Jean-Loup Machu, Abhinav Sharma, Nicolas Girerd, Stefan D. Anker, John G. F. Cleland, Kenneth Dickstein, Gerasimos S. Filippatos, Hans L. Hillege, Chim C Lang, Jozine M. ter Maaten, Marco Metra, Leong Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Aeilko H. Zwinderman, Adriaan A. Voors, Faiez Zannad (Lead / Corresponding author)

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Abstract

Aims: Mineralocorticoid receptor antagonists (MRAs) are recommended (unless contraindicated) to all patients with heart failure with reduced ejection fraction (HFrEF). However, MRAs are still largely underused in routine clinical practice. This study aims to describe the determinants and pattern of use of MRAs in HFrEF.

Methods and Results: BIOSTAT-CHF is a European multicentre, prospective study which enrolled patients suboptimally treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and/or beta-blockers, with the aim of optimizing guideline-based use of these agents. From the original 2516 subjects, this retrospective post hoc analysis included the 1325 patients with an indication for MRA therapy (i.e. left ventricular ejection fraction ≤35%, estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) , K(+) ≤5.0 mmol/L). The mean age was 66.1 ± 12.2 years. At baseline an MRA was prescribed to 741 (56%) patients. Patients who were prescribed MRAs at baseline were younger, more often male, had higher body mass index, lower sodium, higher proportion of hypertension history and ACEi/ARB prescription (all P < 0.05). Of the 1049 patients who completed the baseline plus the 9 month visit, 585 (56%) had an MRA prescribed at baseline and 662 (63%) had an MRA prescribed at 9 months. Among the 585 patients with MRA at baseline, 91 (16%) had discontinued therapy and among the 461 (44%) patients without MRA at baseline 168 (36%) had initiated therapy subsequently. MRA discontinuation was more likely in subjects with higher left ventricular ejection fraction and NYHA class III/IV (P < 0.05 for both). MRA prescription both at baseline and 9 months was not associated with the outcome of death or heart failure hospitalization (adjusted hazard ratio 1.02, 95% confidence interval 0.66-1.58; P = 0.93).

Conclusions: In this prospective observational study across Europe, MRAs were largely under-prescribed and frequently discontinued. Owing to these dynamic changes, outcome inferences are inconclusive.

Original languageEnglish
Pages (from-to)1284-1293
Number of pages10
JournalEuropean Journal of Heart Failure
Volume19
Issue number10
Early online date5 Jun 2017
DOIs
Publication statusPublished - 8 Oct 2017

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Mineralocorticoid Receptor Antagonists
Heart Failure
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Stroke Volume
Prescriptions
Prospective Studies
Glomerular Filtration Rate
Multicenter Studies
Observational Studies

Keywords

  • Mineralocorticoid receptor antagonists
  • Real-life
  • Observational
  • Adherence
  • Prescription

Cite this

Ferreira, J. P., Rossignol, P., Machu, J-L., Sharma, A., Girerd, N., Anker, S. D., ... Zannad, F. (2017). Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF. European Journal of Heart Failure, 19(10), 1284-1293. https://doi.org/10.1002/ejhf.900
Ferreira, João Pedro ; Rossignol, Patrick ; Machu, Jean-Loup ; Sharma, Abhinav ; Girerd, Nicolas ; Anker, Stefan D. ; Cleland, John G. F. ; Dickstein, Kenneth ; Filippatos, Gerasimos S. ; Hillege, Hans L. ; Lang, Chim C ; ter Maaten, Jozine M. ; Metra, Marco ; Ng, Leong ; Ponikowski, Piotr ; Samani, Nilesh J. ; van Veldhuisen, Dirk J. ; Zwinderman, Aeilko H. ; Voors, Adriaan A. ; Zannad, Faiez. / Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction : findings from BIOSTAT-CHF. In: European Journal of Heart Failure. 2017 ; Vol. 19, No. 10. pp. 1284-1293.
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title = "Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF",
abstract = "Aims: Mineralocorticoid receptor antagonists (MRAs) are recommended (unless contraindicated) to all patients with heart failure with reduced ejection fraction (HFrEF). However, MRAs are still largely underused in routine clinical practice. This study aims to describe the determinants and pattern of use of MRAs in HFrEF.Methods and Results: BIOSTAT-CHF is a European multicentre, prospective study which enrolled patients suboptimally treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and/or beta-blockers, with the aim of optimizing guideline-based use of these agents. From the original 2516 subjects, this retrospective post hoc analysis included the 1325 patients with an indication for MRA therapy (i.e. left ventricular ejection fraction ≤35{\%}, estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) , K(+) ≤5.0 mmol/L). The mean age was 66.1 ± 12.2 years. At baseline an MRA was prescribed to 741 (56{\%}) patients. Patients who were prescribed MRAs at baseline were younger, more often male, had higher body mass index, lower sodium, higher proportion of hypertension history and ACEi/ARB prescription (all P < 0.05). Of the 1049 patients who completed the baseline plus the 9 month visit, 585 (56{\%}) had an MRA prescribed at baseline and 662 (63{\%}) had an MRA prescribed at 9 months. Among the 585 patients with MRA at baseline, 91 (16{\%}) had discontinued therapy and among the 461 (44{\%}) patients without MRA at baseline 168 (36{\%}) had initiated therapy subsequently. MRA discontinuation was more likely in subjects with higher left ventricular ejection fraction and NYHA class III/IV (P < 0.05 for both). MRA prescription both at baseline and 9 months was not associated with the outcome of death or heart failure hospitalization (adjusted hazard ratio 1.02, 95{\%} confidence interval 0.66-1.58; P = 0.93).Conclusions: In this prospective observational study across Europe, MRAs were largely under-prescribed and frequently discontinued. Owing to these dynamic changes, outcome inferences are inconclusive.",
keywords = "Mineralocorticoid receptor antagonists, Real-life, Observational, Adherence, Prescription",
author = "Ferreira, {Jo{\~a}o Pedro} and Patrick Rossignol and Jean-Loup Machu and Abhinav Sharma and Nicolas Girerd and Anker, {Stefan D.} and Cleland, {John G. F.} and Kenneth Dickstein and Filippatos, {Gerasimos S.} and Hillege, {Hans L.} and Lang, {Chim C} and {ter Maaten}, {Jozine M.} and Marco Metra and Leong Ng and Piotr Ponikowski and Samani, {Nilesh J.} and {van Veldhuisen}, {Dirk J.} and Zwinderman, {Aeilko H.} and Voors, {Adriaan A.} and Faiez Zannad",
note = "Funding: European Commission (FP7-242209-BIOSTATCHF; EudraCT 2010–020808–29).",
year = "2017",
month = "10",
day = "8",
doi = "10.1002/ejhf.900",
language = "English",
volume = "19",
pages = "1284--1293",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Wiley",
number = "10",

}

Ferreira, JP, Rossignol, P, Machu, J-L, Sharma, A, Girerd, N, Anker, SD, Cleland, JGF, Dickstein, K, Filippatos, GS, Hillege, HL, Lang, CC, ter Maaten, JM, Metra, M, Ng, L, Ponikowski, P, Samani, NJ, van Veldhuisen, DJ, Zwinderman, AH, Voors, AA & Zannad, F 2017, 'Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF', European Journal of Heart Failure, vol. 19, no. 10, pp. 1284-1293. https://doi.org/10.1002/ejhf.900

Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction : findings from BIOSTAT-CHF. / Ferreira, João Pedro; Rossignol, Patrick; Machu, Jean-Loup; Sharma, Abhinav; Girerd, Nicolas; Anker, Stefan D.; Cleland, John G. F.; Dickstein, Kenneth; Filippatos, Gerasimos S.; Hillege, Hans L.; Lang, Chim C; ter Maaten, Jozine M.; Metra, Marco; Ng, Leong; Ponikowski, Piotr; Samani, Nilesh J.; van Veldhuisen, Dirk J.; Zwinderman, Aeilko H.; Voors, Adriaan A.; Zannad, Faiez (Lead / Corresponding author).

In: European Journal of Heart Failure, Vol. 19, No. 10, 08.10.2017, p. 1284-1293.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction

T2 - findings from BIOSTAT-CHF

AU - Ferreira, João Pedro

AU - Rossignol, Patrick

AU - Machu, Jean-Loup

AU - Sharma, Abhinav

AU - Girerd, Nicolas

AU - Anker, Stefan D.

AU - Cleland, John G. F.

AU - Dickstein, Kenneth

AU - Filippatos, Gerasimos S.

AU - Hillege, Hans L.

AU - Lang, Chim C

AU - ter Maaten, Jozine M.

AU - Metra, Marco

AU - Ng, Leong

AU - Ponikowski, Piotr

AU - Samani, Nilesh J.

AU - van Veldhuisen, Dirk J.

AU - Zwinderman, Aeilko H.

AU - Voors, Adriaan A.

AU - Zannad, Faiez

N1 - Funding: European Commission (FP7-242209-BIOSTATCHF; EudraCT 2010–020808–29).

PY - 2017/10/8

Y1 - 2017/10/8

N2 - Aims: Mineralocorticoid receptor antagonists (MRAs) are recommended (unless contraindicated) to all patients with heart failure with reduced ejection fraction (HFrEF). However, MRAs are still largely underused in routine clinical practice. This study aims to describe the determinants and pattern of use of MRAs in HFrEF.Methods and Results: BIOSTAT-CHF is a European multicentre, prospective study which enrolled patients suboptimally treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and/or beta-blockers, with the aim of optimizing guideline-based use of these agents. From the original 2516 subjects, this retrospective post hoc analysis included the 1325 patients with an indication for MRA therapy (i.e. left ventricular ejection fraction ≤35%, estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) , K(+) ≤5.0 mmol/L). The mean age was 66.1 ± 12.2 years. At baseline an MRA was prescribed to 741 (56%) patients. Patients who were prescribed MRAs at baseline were younger, more often male, had higher body mass index, lower sodium, higher proportion of hypertension history and ACEi/ARB prescription (all P < 0.05). Of the 1049 patients who completed the baseline plus the 9 month visit, 585 (56%) had an MRA prescribed at baseline and 662 (63%) had an MRA prescribed at 9 months. Among the 585 patients with MRA at baseline, 91 (16%) had discontinued therapy and among the 461 (44%) patients without MRA at baseline 168 (36%) had initiated therapy subsequently. MRA discontinuation was more likely in subjects with higher left ventricular ejection fraction and NYHA class III/IV (P < 0.05 for both). MRA prescription both at baseline and 9 months was not associated with the outcome of death or heart failure hospitalization (adjusted hazard ratio 1.02, 95% confidence interval 0.66-1.58; P = 0.93).Conclusions: In this prospective observational study across Europe, MRAs were largely under-prescribed and frequently discontinued. Owing to these dynamic changes, outcome inferences are inconclusive.

AB - Aims: Mineralocorticoid receptor antagonists (MRAs) are recommended (unless contraindicated) to all patients with heart failure with reduced ejection fraction (HFrEF). However, MRAs are still largely underused in routine clinical practice. This study aims to describe the determinants and pattern of use of MRAs in HFrEF.Methods and Results: BIOSTAT-CHF is a European multicentre, prospective study which enrolled patients suboptimally treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and/or beta-blockers, with the aim of optimizing guideline-based use of these agents. From the original 2516 subjects, this retrospective post hoc analysis included the 1325 patients with an indication for MRA therapy (i.e. left ventricular ejection fraction ≤35%, estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) , K(+) ≤5.0 mmol/L). The mean age was 66.1 ± 12.2 years. At baseline an MRA was prescribed to 741 (56%) patients. Patients who were prescribed MRAs at baseline were younger, more often male, had higher body mass index, lower sodium, higher proportion of hypertension history and ACEi/ARB prescription (all P < 0.05). Of the 1049 patients who completed the baseline plus the 9 month visit, 585 (56%) had an MRA prescribed at baseline and 662 (63%) had an MRA prescribed at 9 months. Among the 585 patients with MRA at baseline, 91 (16%) had discontinued therapy and among the 461 (44%) patients without MRA at baseline 168 (36%) had initiated therapy subsequently. MRA discontinuation was more likely in subjects with higher left ventricular ejection fraction and NYHA class III/IV (P < 0.05 for both). MRA prescription both at baseline and 9 months was not associated with the outcome of death or heart failure hospitalization (adjusted hazard ratio 1.02, 95% confidence interval 0.66-1.58; P = 0.93).Conclusions: In this prospective observational study across Europe, MRAs were largely under-prescribed and frequently discontinued. Owing to these dynamic changes, outcome inferences are inconclusive.

KW - Mineralocorticoid receptor antagonists

KW - Real-life

KW - Observational

KW - Adherence

KW - Prescription

U2 - 10.1002/ejhf.900

DO - 10.1002/ejhf.900

M3 - Article

C2 - 28580625

VL - 19

SP - 1284

EP - 1293

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 10

ER -