Aldosterone Antagonists: The Most Underutilized Class of Heart Failure Medications

Guglin, Maya; Awad, Khaled Esmaeel; Polavaram, Latha; Vankayala, Hema
January 2007
American Journal of Cardiovascular Drugs;2007, Vol. 7 Issue 1, p75
Academic Journal
BACKGROUND: Aldosterone antagonists have been proven to be beneficial in severe heart failure (HF) as a result of systolic dysfunction. We sought to determine if there is a disparity in their utilization compared with ACE inhibitors and β-adrenoceptor antagonists (β-blockers). METHODS: In the first part of the study, we asked physicians to answer a questionnaire presenting a hypothetical HF patient. In the second part, we reviewed hospital charts of patients with HF exacerbation. RESULTS: Spironolactone was used less frequently than other drugs. At home, 75.0% of patients were receiving ACE inhibitors, 66.7% received β-blockers, and 38.2% received spironolactone (p < 0.001). During the admission, 93.1% of patients received ACE inhibitors and 58.3% received spironolactone (p < 0.001). CONCLUSIONS: Despite good evidence, underutilization of aldosterone antagonists in patients matching the population of the RALES (Randomized Aldactone Evaluation Study) trial persists in both outpatient and inpatient settings. The difference between the usage of ACE inhibitors and spironolactone is significant in patients with systolic dysfunction equally qualifying for both medications.


Related Articles

  • Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease. Roblek, Tina; Trobec, Katja; Mrhar, Ales; Lainscak, Mitja // Archives of Medical Science;Oct2014, Vol. 10 Issue 5, p920 

    Introduction: Polypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients. Material and...

  • Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials. Tacon, Catherine; McCaffrey, John; Delaney, Anthony // Intensive Care Medicine;Mar2012, Vol. 38 Issue 3, p359 

    Purpose: Dobutamine is recommended for patients with severe heart failure; however uncertainty exists as to its effect on mortality. This study aims to critically review the literature to evaluate whether dobutamine, compared with placebo or standard care, is associated with lower mortality and...

  • Aldosterone antagonists underutilised in HF.  // PharmacoEconomics & Outcomes News;4/21/2007, Issue 526, p7 

    The article focuses on a study on the utilization of aldosterone antagonists in the treatment of heart failure (HF) in inpatient and outpatient settings in the U.S. published in the 2007 issue of the "American Journal of Cardiovascular Drugs." The study found that the antagonist is underutilized...

  • An overview of how to manage patients with heart failure. Simpson, Sue // Journal of Renal Nursing;2011, Vol. 3 Issue 2, p76 

    Sue Simpson provides an overview of the key aspects of care and management of patients with heart failure. She describes the symptoms of heart failure and their classification, which despite the arrival of new technology, have been used for over five decades. The main focus of article, however,...

  • Detection of spironolactone-associated hyperkalaemia following the Randomized Aldactone Evaluation Study (RALES). Hauben, Manfred; Reich, Lester; Gerrits, Charles M.; Madigan, David // Drug Safety;2007, Vol. 30 Issue 12, p1143 

    Introduction: A population-based analysis has suggested that the publication of the RALES (Randomized Aldactone Evaluation Study) in late 1999 was associated with both the wider use of spironolactone to treat heart failure and a corresponding increase in hyperkalaemia-associated...

  • Lack of adherence in heart failure therapy.  // Hospital Home Health;Apr2010, Vol. 27 Issue 4, p45 

    The article reports on a research finding which reveals that majority of heart failure patients who are eligible for aldosterone antagonist therapy are not receiving the said treatment.

  • Lack of adherence in heart failure therapy.  // Hospital Home Health;May2010, Vol. 27 Issue 5, p52 

    The article discusses the study which reveals that physicians and hospitals failed to adhere the adoption of new treatment recommendations aldosterone antagonist therapy to help improve the patient outcomes in hospitalized heart failure patients in the U.S.

  • The Risks and Benefits of Therapy with Aldosterone Receptor Antagonist Therapy. Sica, Domenic A. // Current Drug Safety;Jan2007, Vol. 2 Issue 1, p71 

    Spironolacotone and eplerenone are mineralocorticoid-blocking agents. These compounds block both the epithelial and non-epithelial actions of aldosterone with the latter assuming increasing clinical importance. Spironolactone and eplerenone both effectively reduce blood pressure either as mono-...

  • Aldosterone Antagonists � Last Man Standing? Armstrong, Paul W. // New England Journal of Medicine;1/6/2011, Vol. 364 Issue 1, p79 

    The author reflects on aldosterone antagonists in the treatment of heart failure. It says that in the turn of the millennium, there are four cardiac medicines developed before 1960 that survived namely aspirin, digoxin, warfarin and spironolactone. It highlights two studies whose findings have...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics