Table 1.
Characteristics of patients with prior hospitalization for heart failure with reduced left ventricular ejection fraction at the time of initiation of a mineralocorticoid receptor antagonist, stratified by death/hospitalization, serum potassium measure, or no measure in the 7 days after initial MRA dispensing.
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EXCLUDED due to death or hospitalization within 7 days | ELIGIBLE for 7 day testing comparisons N=443 (90.4% of 490)
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| Characteristic | TESTING ≤7 days from MRA dispensing | NO testing ≤7 days of MRA dispensing | P value* | |
| N=47 (9.6% of 490) | N=237 (53.5% of 443) | N=206 (46.5% of 443) | ||
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| Age in years, median (IQR) | 76 (66, 84) | 73 (62, 81) | 74 (61, 80) | 0.97 |
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| Age categories, n (%) | ||||
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| Age ≤65 | 10 (21.3%) | 76 (32.1%) | 64 (31.1%) | 0.58 |
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| Age 65-74 | 10 (21.3%) | 60 (25.3%) | 45 (21.8%) | |
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| Age ≥75 | 27 (57.5%) | 101 (42.6%) | 97 (47.1%) | |
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| Female gender, n (%) | 22 (46.8%) | 87 (36.7%) | 73 (35.4%) | 0.78 |
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| Cardiac History, n (%) | ||||
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| LVEF, median (IQR) | 0.25 (0.20, 0.33) | 0.25 (0.20-0.33) | 0.25 (0.20-0.30) | 0.65 |
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| Missing LVEF | 8 (17.0%) | 82 (34.6%) | 56 (27.2%) | 0.12 |
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| Acute myocardial infarction | 7 (14.9%) | 39 (16.5%) | 23 (11.2%) | 0.11 |
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| Coronary artery bypass surgery | 2 (4.3%) | 17 (7.2%) | 8 (3.9%) | 0.14 |
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| Coronary stent or angioplasty | 5 (10.6%) | 30 (12.7%) | 24 (11.7%) | 0.75 |
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| Atrial fibrillation or flutter | 9 (19.1%) | 48 (20.3%) | 33 (16.0%) | 0.25 |
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| Ventricular tachycardia | 2 (4.3%) | 16 (6.8%) | 4 (1.9%) | 0.02 |
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| Rheumatic valvular disease | 7 (14.9%) | 11 (4.6%) | 5 (2.4%) | 0.21 |
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| ICD | 4 (8.5%) | 19 (8.0%) | 18 (8.7%) | 0.78 |
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| Pacemaker | 5 (10.6%) | 23 (9.7%) | 18 (8.7%) | 0.73 |
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| Medical History, n (%) | ||||
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| Ischemic stroke or TIA | 4 (8.5%) | 16 (6.8%) | 9 (4.4%) | 0.28 |
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| Peripheral arterial disease | 16 (34.0%) | 27 (11.4%) | 26 (12.6%) | 0.69 |
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| Dyslipidemia | 27 (57.4%) | 126 (53.2%) | 97 (47.1%) | 0.20 |
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| Hypertension | 22 (46.8%) | 117 (49.4%) | 100 (48.5%) | 0.86 |
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| Diabetes mellitus | 9 (19.1%) | 42 (17.7%) | 38 (18.4%) | 0.42 |
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| Diagnosed dementia | 8 (17.0%) | 25 (10.5%) | 22 (10.7%) | 0.96 |
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| Diagnosed depression | 8 (17.0%) | 51 (21.5%) | 38 (18.4%) | 0.42 |
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| Chronic lung disease | 20 (42.6%) | 85 (35.9%) | 80 (38.8%) | 0.52 |
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| Chronic liver disease | 2 (4.3%) | 9 (3.8%) | 13 (6.3%) | 0.23 |
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| Systemic cancer | 12 (25.5%) | 16 (6.8%) | 18 (8.7%) | 0.43 |
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| Medications at initial dispensing ambulatory MRA | ||||
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| Spironolactone | 47 (100%) | 235 (99.2%) | 205 (99.5%) | 0.99 |
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| Eplerenone | 0 (0%) | 2 (0.8%) | 1 (0.5%) | |
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| Starting MRA dose, mg/24hr | ||||
| ≤12.5 mg | 11 (23.4%) | 92 (38.8%) | 63 (30.6%) | 0.08 |
| 25 mg | 20 (63.8%) | 127 (53.6%) | 132 (64.1%) | |
| ≥50 mg | 6 (12.8%) | 18 (7.6%) | 11 (5.3%) | |
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| Potassium supplement | 18 (38.3%) | 107 (45.1%) | 75 (36.4%) | 0.06 |
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| Loop diuretic | 32 (68.1%) | 187 (78.9%) | 155 (75.2%) | 0.36 |
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| Thiazide-type diuretic | 4 (8.5%) | 33 (13.9%) | 19 (9.2%) | 0.13 |
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| ACEI | 22 (46.8%) | 156 (65.8%) | 135 (65.6%) | 0.95 |
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| ARB | 2 (4.3%) | 24 (10.1%) | 24 (11.7%) | 0.61 |
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| Beta-blocker | 26 (55.3%) | 190 (80.2%) | 164 (79.6%) | 0.88 |
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| Digoxin | 17 (36.2%) | 104 (43.9%) | 89 (43.2%) | 0.89 |
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| Vitals | ||||
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| Systolic blood pressure, mmHg, median (IQR) | 121 (108, 132) | 122 (110, 140) | 120 (110, 140) | 0.90 |
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| Missing Systolic BP | 5 (10.6%) | 11 (4.6%) | 17 (8.3%) | 0.12 |
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| <=90 | 5 (10.6%) | 13 (5.5%) | 9 (4.4%) | 0.30 |
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| 91-110 | 3 (6.4%) | 58 (24.5%) | 52 (25.2%) | |
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| 111-140 | 13 (27.7%) | 103 (43.5%) | 89 (43.2%) | |
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| 141-160 | 21 (44.7%) | 40 (16.9%) | 22 (10.7%) | |
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| >160 | 3 (6.4%) | 12 (5.1%) | 17 (8.3%) | |
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| Heart rate, bpm, median (IQR) | 80 (64, 96) | 83.5 (72, 99) | 78 (66, 89) | <0.001 |
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| Missing heart rate | 5 (10.6%) | 11 (4.6%) | 18 (8.7%) | 0.08 |
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| Discharged to a facility location (nursing home, skilled nursing, rehab unit, or another hospital) | 9 (3.8%) | 12 (5.8%) | ||
p values are from Fisher’s exact test and chi-square test for categorical variables and Wilcoxon Rank Sum for continuous variables, and compare testing within 7 days to no testing within 7 days.
MRA=mineralocorticoid receptor antagonist; IQR=interquartile range; LVEF=left ventricular ejection fraction; ICD=implantable cardioverter-defibrillator; TIA=transient ischemia attack; ACEI=angiotensin converting enzyme inhibitor; ARB=angiotensin receptor blocker.