Prevalence of mineralocorticoid antagonist prescription after ST-elevation myocardial infarction with impaired left ventricular function: a single centre experience. (Preprint)

BACKGROUND Evidence suggests long term benefit from angiotensin converting enzyme inhibition (ACE-I) or angiotensin receptor blockade (ARB), beta-adrenoceptor antagonism and mineralocorticoid antagonism (MRA) in patients with left ventricular dysfunction After myocardial infarction. However, despite clinical evidence and clearly articulated guidelines, several studies suggest low rates of prescription of some medications like MRA in the target group with post- myocardial infarction left ventricular dysfunction (MI LVD), both in Australia and other countries OBJECTIVE To identify the real world medication prescription in ST elevation myocardial infarction (STEMI) patients with impaired left ventricular function METHODS We studied prescription trends in 152 consecutive STEMI patients between August 2013 and December 2016 admitted to a single referral centre who also had a pre-discharge echo that demonstrated at least moderate Left ventricular dysfunction RESULTS The average age was 63 years. Most patients were male (78%) and the average BMI was 28 (±6). 132 patients [87% (80% - 92%)] were prescribed ACE-I/ARBs, 144 patients received beta-adrenoceptor antagonists (95% [90% - 98%]), 147 patients (97%) received DAPT and 146 patients (95%) received statins post-STEMI. 45 eligible patients (30% [23% - 28%]) received an MRA. Younger patients were more likely to be prescribed an MRA (p = 0.008). The MRA prescribed cohort were younger, 59 versus 64 years, had marginally better renal function with average eGFR 108 vs 91 mL/min/1.73m2 and lower rates of stage ≥III CKD 11 vs 22 (p <0.05) CONCLUSIONS Our study shows a substantial treatment gap, in that a majority of patients with impaired LV dysfunction after STEMI with symptoms of heart failure or diabetes are not receiving medications in the MRA class, despite proven benefit. As such, the root causes of this treatment gap require elucidation in a multi-centre context.