Heart failure & cardiomyopathies
Mineralocorticoid receptor antagonist (MRA) use in UK heart failure care: a national primary care cohort study
Authors' conclusion
MRAs are underused in people with HFrEF in the UK. Although prescribing increased between 2014 and 2020, half of the cohort still did not receive the therapy. Older age, gender, comorbidities and co-prescriptions were linked to MRA underuse. Understanding the factors contributing to underprescribing at a population level should be used to inform quality improvement strategies.
Study context
- Population
- People with heart failure with reduced ejection fraction (HFrEF) in primary care electronic health record (EHR) data from The Health Improvement Network database, 2014–2020people with HFrEF, 12,150 person-years eligible for MRA treatment
- Participants
- 24,135 people
- Outcome
- MRA prescription rate
- Follow-up
- 2014-2020
Main finding
As reported in the abstract
MRA prescription rate increased from
41%
MRA prescription rate increased to
55%
Observational data: associations, not effects.
Further findings
Factors inversely associated with MRA prescription
| Estimate | ||
|---|---|---|
| AgeInverse association · mixed effects logistic regression | OR per 1 SD 0.02 (95% CI 0.01–0.03) | |
| Increasing glomerular filtration rateInverse association · mixed effects logistic regression | OR per 1 SD 0.37 (95% CI 0.25–0.55) | |
| HypertensionInverse association; interval as printed · mixed effects logistic regression | OR 0.21 (95% CI 0.40–0.78) | |
| Prescription of antihypertensivesInverse association · mixed effects logistic regression | OR 0.03 (95% CI 0.02–0.07) | |
| 0.050.21520Ratio (log scale) |
Factors associated with MRA prescription
| OR (95% CI) | ||
|---|---|---|
| Male genderPositive association | 6.31 (3.20–12.4) | |
| Dilated cardiomyopathyPositive association | 25.9 (7.48–89.4) | |
| Prescription of sacubitril/valsartanPositive association | 214 (56–823) | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | OR (per year after study start) (95% CI) | |
|---|---|---|
| Factors associated with MRA prescriptionCalendar year · positive association | 2.17 (1.85–2.54) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
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