Retrospective review of in hospital use of mineralocorticoid receptor antagonists for high risk patients following myocardial infarction

BACKGROUND There is little data regarding use of mineralocorticoid antagonists (MRAs) for patients reduced LV ejection fraction (LVEF) following acute myocardial infarction (MI). We determined the frequency and temporal trends of MRA use in these patients. METHODS We performed a retrospective review of all cases of acute MI between June 1, 2010 and April 1, 2012. Patients were considered eligible for MRA therapy if they were admitted with acute MI with LVEF ≤ 40 % and had heart failure symptoms or a history of diabetes. RESULTS Of 3910 cases of acute MI, 332 patients were considered eligible for MRA therapy. MRA therapy was prescribed for 92/332 (28 %) eligible patients, while 66 of 1142 (6 %) of ineligible patients were so treated. Over the study period, usage in eligible and ineligible patients rose significantly (22 to 30 %, p = 0.08 and 4 to 7 %, p = 0.04 respectively). CONCLUSIONS Prescription of MRAs for eligible patients occurred in a minority of patients, and demonstrated a modest increase over time. In patients without an indication for MRAs, a similar trend was observed. Further study is required to better understand barriers to appropriate use of MRAs in this patient population.