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eplerenone was initiated. However, the occurrence of these
adverse effects did not eliminate the survival benefit of
aldosterone antagonist therapy. This study further reiterates the importance of utilizing appropriate therapy as contraindications were minimal as compared with other
studies. Inampudi et al12 reported that spironolactone therapy was not associated with a reduction in HF readmission
and all-cause mortality. In hospitalized patients with
reduced EF and advanced chronic kidney disease, spironolactone use was associated with higher all-cause readmission, but no association was found with all-cause mortality
or HF readmission. This study found more frequent readmissions in patients at 30 and 90 days who did not receive
an aldosterone antagonist at discharge compared with
those who received aldosterone antagonist, although not
statistically significant likely due to population size. The
use of aldosterone antagonist may provide a small beneficial effect as well as cost-benefit. Interestingly, patients
who had a contraindication to therapy had increased readmission rates compared with those without contraindication. Despite many factors that could contribute to
readmission, it could be suggested that patients with
reduced EF regardless of pharmacotherapy would be at
increased risk of readmission.
Simopoulos et al13 recently reported that eplerenone
decreased the incidence of postoperative atrial fibrillation in
patients undergoing on-pump cardiac surgery, when added to
standard HF treatment. The majority of patients in this study
had EF <40%.13
Limitations to our investigation include the inherent problems with retrospective studies. In addition, this was a singlecenter study, and a larger patient population may have shown a
difference in 30- and 90-day readmission rates between groups.
Current and past literature reiterates the proven benefits
of aldosterone antagonists in certain patient populations,
especially those with reduced EF HF. Despite this evidence,
these agents remain underutilized.6,7,14-18 Finally, very recent
evidence suggests reduced risk of hyperkalemia during the
treatment of HF with aldosterone antagonists by use of sacubitril/valsartan versus enalapril.19

Conclusions
Aldosterone antagonists still remain underutilized despite
current clinical guideline recommendations. Members of the
health care team need to be more vigilant regarding appropriate use of aldosterone antagonists to help ensure optimal
patient outcomes.
Authors' Note
At the time of this study, Dr. Patterson was a PGY2 Internal
Medicine Pharmacy Resident at Methodist University Hospital,
Memphis, and Dr. Ulrich was a Doctor of Pharmacy candidate
at the University of Tennessee Health Science Center. Dr. Patterson
is currently with Methodist South Hospital.

Hospital Pharmacy 52(10)
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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