Table 2.
Pre-initiation laboratory testing of patients with prior hospitalization for heart failure with reduced left ventricular ejection fraction (HFREF) at the time of initiation of a mineralocorticoid receptor antagonist (MRA), stratified by 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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| Potassium, serum, prior to initiation of MRA (mmol/L), median, (IQR) (N=299) | 4.1 (3.6, 4.4) | 4.2 (3.9-4.5) | 4.1 (3.9-4.5) | 0.61 |
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| Potassium, serum, prior to initiation of MRA (mmol/L), n (%) | ||||
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| >5.51 | 0 | 0 | 0 | 0.31 |
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| 5.01-5.50 | 0 | 5 (2.1%) | 1 (0.5%) | |
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| 4.51-5.00 | 5 (13.5%) | 30 (12.7%) | 29 (14.1%) | |
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| 4.01-4.50 | 24 (37.8%) | 65 (27.4%) | 43 (20.9%) | |
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| 3.51-4.00 | 9 (24.3%) | 61 (25.7%) | 42 (20.4%) | |
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| <=3.50 | 9 (24.3%) | 10 (4.2%) | 13 (6.3%) | |
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| Labs not available: Hospitalized within prior 30 days† | 7 (14.9%) | 51 (21.5%) | 66 (32.0%) | 0.012 |
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| No labs, no hospitalization within prior 30 days | 3 (6.4%) | 15 (6.3%) | 12 (5.8%) | 0.83 |
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| Creatinine, serum, prior to initiation of MRA (mg/dL), median, (IQR) (N=307) | 1.1 (0.9,1.5) (N=47) | 1.2 (1.0-1.4) (N=176) | 1.1 (0.9-1.4) (N=131) | 0.10 |
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| Creatinine, serum, prior to initiation of MRA (mg/dL), n (%) | ||||
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| >3.00 | 1 (2.8%) | 2 (0.8%) | 0 (0%) | 0.62 |
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| 2.51-3.00 | 0 | 3 (1.3%) | 2 (1.0%) | |
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| 2.01-2.50 | 4 (11.1%) | 6 (2.5%) | 3 (1.5%) | |
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| 1.51-2.00 | 3 (8.3%) | 15 (6.3%) | 13 (6.3%) | |
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| 1.01-1.50 | 15 (41.7%) | 98 (41.4%) | 63 (30.6%) | |
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| <=1.00 | 13 (36.1%) | 52 (21.9%) | 50 (24.3%) | |
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| Labs not available, hospitalized within prior 30 days† | 8 (17.0%) | 48 (20.3%) | 63 (30.6%) | 0.012 |
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| No labs, no hospitalization within prior 30 days | 3 (6.4%) | 13 (5.5%) | 12 (5.8%) | 0.88 |
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.
Missing labs prior to MRA initiation are primarily due to hospitalization in prior 30 days from hospital facilities where laboratory data was unavailable; 81% of subjects missing an outpatient serum potassium measure prior to MRA start were hospitalized in prior 30 days. Percentages were not significantly different for subjects with and without potassium monitoring within 7 days of MRA start: 76.9% and 84.6%, respectively; p=0.24.
MRA=mineralocorticoid receptor antagonist; IQR=interquartile range.