In Reply: Dr Fayssoil raises a question regarding whether the strength of associations of study variables with aldosterone antagonist therapy prescription differed in the subsets of patients with ischemic and nonischemic HF. Our multivariable model included ischemic etiology, which was not predictive of aldosterone antagonist prescription (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.89-1.07; P = .64). We performed subgroup analyses of patients with ischemic and nonischemic etiology of HF to determine factors associated with aldosterone antagonist prescription. Patient and hospital factors associated with aldosterone antagonist use were similar in the subgroups of patients with ischemic and nonischemic etiology for HF. The exceptions were that African American race (aOR, 1.29; 95% CI, 1.08-1.55; P = .005), female sex (aOR, 1.13; 95% CI, 1.01-1.26; P = .03), depression (aOR, 1.23; 95% CI, 1.05-1.44; P = .009), and pacemaker implantation (aOR, 1.25; 95% CI, 1.08-1.46; P = .003) were associated with aldosterone antagonist use only in the ischemic subgroup; alcohol history (aOR, 1.29; 95% CI, 1.03-1.61; P = .03) was associated with aldosterone antagonist use only in the nonischemic subgroup.
Albert NM, Fonarow GC, Hernandez AF. Aldosterone Antagonists in Patients With Heart Failure—Reply. JAMA. 2010;303(9):833-835. doi:10.1001/jama.2010.187