Background: Evidence showed better clinical outcomes with Mineralocorticoid Receptor Antagonists (MRAs) use in post-myocardial infarction (MI) patients. There is underutilization of Spironolactone in heart failure (HF) settings in Saudi Arabia, necessitating the need to evaluate our practice in prescribing MRAs for post-MI patients. Therefore, our study aimed to assess the rate of compliance with the guideline recommendation to initiate MRAs in patients post-MI who have an Ejection Fraction (EF) of 40% or less and symptomatic HF or diabetes.

Methodology: A retrospective observational study was conducted at King Fahad Medical City. All adult patients who underwent cardiac catheterization from 2021 to 2023 were screened for eligibility through their medical records.

Results: A total of 1830 patients were screened, among those, 347 patients were included and eligible for spironolactone therapy. The mean age was 57.4 ± 12.6 years, and 83.90% of them were males. Among those 347 patients, 70.6% were diagnosed to have ST-segment Elevation MI (STEMI) with a mean EF of 21.8 ± 15.2 %. From the included patients, 232 (66.9%) had symptomatic HF and 251 (72.3%) had diabetes. Most of the included patients were on Renin Angiotensin Aldosterone inhibitors (RAASI) and Beta blockers (BB); 316 (91.1%) and 343 (98.8%) respectively. Our results showed that Spironolactone was initiated in only 168 (48.4%) patients from all MRAs eligible patients. From those, Spironolactone was started early in 121 (72.0%) patients. Spironolactone monitoring parameters were done in 135 (80.4%), 42 (25.0%), 25 (14.9%), and 24 (14.3%) within one week, week 4, week 8, and week 12 of spironolactone initiation, respectively.

Conclusion: MRAs use in eligible patients post-MI is underutilized, highlighting an urgent need to improve adherence to the guideline recommendations in order to improve the clinical outcomes. Further investigations are warranted to identify barriers affecting MRAs initiation and monitoring from prescribers' perspectives.