{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:53:25Z","timestamp":1787802805832,"version":"build-2784847793"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The effectiveness and safety of mineralocorticoid receptor antagonists (MRA) in acute heart failure (HF) is uncertain. We sought to describe the prescription of spironolactone during acute HF and whether early treatment is effective and safe in a real\u2010world setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective cohort study of adult (\u226518 years) nonpregnant patients hospitalized with new\u2010onset HF with reduced ejection fraction (HFrEF, defined by ejection fraction \u226440%) within 15 Kaiser Permanente Southern California medical centers between 2016 and 2021. Early treatment was defined by spironolactone prescription at discharge. The primary effectiveness outcome was a composite of HF readmission or all\u2010cause mortality at 180 days. Safety outcomes were hypotension and hyperkalemia at 90 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2318 HFrEF patients, 368 (15.9%) were treated with spironolactone at discharge. After 1:2 propensity score matching, 354 early treatment and 708 delayed\/no treatment patients were included in the analysis. The median age was 63 (IQR: 52\u201374) years; 61.6% were male, and 38.6% were White. By 90 days, ~20% had crossed over in the two groups. Early treatment was not associated with the composite outcome at 180 days (HR [95% CI]: 0.81 [0.56\u20131.17]), but a trend towards benefit by 365 days that did not reach statistical significance (0.78 [0.58\u20131.06]). Early treatment was also associated with hyperkalemia (subdistribution HR [95% CI]: 2.33 [1.30\u20134.18]) but not hypotension (0.93 [0.51\u20131.72]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early treatment with spironolactone at discharge for new\u2010onset HFrEF in a real\u2010world setting did not reduce the risk of HF readmission or mortality in the first year after discharge. The risk of hyperkalemia was increased.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.13317","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T06:49:05Z","timestamp":1709102945000},"page":"267-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness and safety of early treatment with spironolactone for new\u2010onset acute heart failure"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7072-9679","authenticated-orcid":false,"given":"Cheng\u2010Wei","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Hospital Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"},{"name":"Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon S.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"},{"name":"Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u2010Lu Amy","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siamak","family":"Kohan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"Mefford","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie S.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Subject","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong Q.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Sum","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA"},{"name":"Department of Cardiology Kaiser Permanente Los Angeles Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"issue":"18","key":"e_1_2_7_5_1","first-page":"895","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"145","author":"Heidenreich PA","year":"2022","journal-title":"Circulation"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2018.09.011"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.11.006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.14795"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-019-1175-3"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.03.007"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.0496"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02076-1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvaa132"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.5892"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.08.036"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.05.062"},{"key":"e_1_2_7_18_1","unstructured":"Fast facts. Kaiser Permanente. Accessed November 6 2022.https:\/\/about.kaiserpermanente.org\/who-we-are\/fast-facts"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/12-031"},{"key":"e_1_2_7_20_1","first-page":"1","article-title":"Association between coronary artery disease testing in patients with new\u2010onset heart failure and heart failure readmission and mortality","volume":"18","author":"Huang C\u2010W","year":"2024","journal-title":"J Gen Intern Med"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000221"},{"issue":"8","key":"e_1_2_7_22_1","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.121.008538","article-title":"Disparity in the setting of incident heart failure diagnosis","volume":"14","author":"Sandhu AT","year":"2021","journal-title":"Circ Hear Fail"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.07.081"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.17.2105"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.01.030"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.12791"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9094-x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.3511"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31825f64d0"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/12-141"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq224"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.433"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/03610910902859574"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.06.039"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/xJAHA.111.000018"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.09.011"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.1900"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4162"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2020.04.003"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.13317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T16:41:22Z","timestamp":1760632882000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.13317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,28]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/jhm.13317"],"URL":"https:\/\/doi.org\/10.1002\/jhm.13317","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,28]]},"assertion":[{"value":"2023-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}