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Mineralocorticoid Receptor Antagonist Utilization in a Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population

A Cross-Sectional Study

Joyner, Kayla Rena PharmD, BCPS1; Soric, Mate Michael PharmD, BCPS*,2,3; Boyle, Jaclyn Ann MS, MBA, PharmD, BCPS3,4; Moorman, John Michael PharmD, BCPS3,5; Fredrickson, Mary Elizabeth PharmD, BCPS3; Turosky, Jodie Zlotnik BSPharm, BCPS3,6; Kleven, Casondra Lee PharmD7

doi: 10.1097/MJT.0000000000000823
Original Investigation: PDF Only

Background: Mineralocorticoid receptor antagonists (MRAs) improve survival among patients with heart failure with reduced ejection fraction (HFrEF); however, studies have identified low utilization rates. No study has evaluated the prevalence and predictors of MRA prescribing in a nationally representative outpatient cohort.

Study Question: What is the prevalence and predictors of MRA prescribing among outpatients with HFrEF in the United States?

Study Design: A national cross-sectional secondary analysis of the National Ambulatory Medical Care Survey from 2007 to 2014 including all office visits for HFrEF in patients aged >55 years. Office visits involving patients with any history of chronic renal failure and hyperkalemia were excluded.

Measures and Outcomes: The primary end point was the MRA prescribing rate. Multivariable logistic regression models were created to identify predictors of use.

Results: In total, 1259 visits were eligible for inclusion, representing more than 30 million visits when weighted. MRAs were initiated or continued in 11.1% of HFrEF visits (95% confidence interval [CI] 8.8–13.8). In the full model, predictors included diabetes mellitus (OR 2.27; 95% CI 1.12–4.61), Northeast region (OR 0.20; 95% CI 0.05–0.74), and ≥4 chronic conditions (OR 0.26; 95% CI 0.10–0.71). Among symptomatic patients, predictors included non-Hispanic black patients (OR 4.55; 95% CI 1.81–11.43), patients aged 65–74 years (OR 3.38; 95% CI 1.53–7.44), and office systolic blood pressure >130 mm Hg (OR 0.31; 95% CI 0.16–0.60). Physician specialty, visit year, patient sex, and payor type were not significant predictors of MRA utilization.

Conclusions: Although significant data support the use of MRA in HFrEF, utilization is lower than previously estimated.

1Pharmacy Practice, Shenandoah University Bernard J. Dunn School of Pharmacy, Winchester, VA;

2Department of Pharmacy, University Hospitals Geauga Medical;

3Pharmacy Practice, Northeast Ohio Medical University College of Pharmacy, Rootstown, OH;

4Department of Pharmacy, University Hospitals Portage Medical Center, Ravenna, OH;

5Department of Pharmacy, Cleveland Clinic Akron General Medical Center, Akron, OH;

6Pharmacy, St. Vincent Charity Medical Center, Cleveland, OH; and

7Medication Managers/RxConcile, Mason, OH.

Address for correspondence: Mate Michael Soric, PharmD, BCPS, Clinical Pharmacy Specialist, Internal Medicine University Hospitals Geauga Medical Center Vice Chair, Practice-Based Research and Associate Professor, Pharmacy Practice Northeast Ohio Medical University College of Pharmacy, 4209 State Route 44 P.O. Box 95 Rootstown, OH 44272. E-mail:

Supported by Northeast Ohio Medical University.

Presented in abstract form at the 2017 American College of Clinical Pharmacy Annual Meeting, October 10, 2017, Phoenix, AZ.

The authors have no conflicts of interest to declare.

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