{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T12:39:45Z","timestamp":1771850385361,"version":"3.50.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Despite concerns about mineralocorticoid receptor antagonist therapies (MRAs) underuse and misuse in patients with heart failure, temporal and institutional variations of MRA prescription have not been reported.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We studied a national sample of veterans hospitalized for heart failure between 2003 and 2009 and left ventricular ejection fraction &lt;40%. We identified ideal and non\u2010ideal candidates for MRA therapy based on American College of Cardiology\/American Heart Association guidelines. We measured temporal trends and hospital variation of MRA prescriptions within 90 days after discharge. We determined the median odds ratio (MOR), a measure of the relative odds of an MRA prescription for 2 individuals with similar characteristics discharged at 2 randomly selected hospitals. From 37\u00a0126 patients (n=131 hospitals), 9355 were ideal\u2010MRA candidates, and 4056 were non\u2010ideal candidates. Among ideal candidates, 36% received an MRA, but there was a decline in use (41% in 2003 to 31% in 2009,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Of non\u2010ideal candidates, 27% received an MRA with a decline in use (34% in 2003 to 22% in 2009,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Hospital MRA prescription ranged from 0% to 71% for ideal candidates and 0% to 100% for non\u2010ideal candidates. The median odds ratios of MRA prescription for ideal and non\u2010ideal candidates were 1.44 and 1.36, respectively; a median odds ratio &gt;1.2 indicates significant practice\u2010level variation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">There was decreasing MRA use between 2003 and 2009 with wide institutional variation in MRA prescription, which suggests opportunities for improvement to stimulate MRA use in ideal candidates while further reducing use in those with contraindications.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.115.002268","type":"journal-article","created":{"date-parts":[[2015,12,24]],"date-time":"2015-12-24T03:35:13Z","timestamp":1450928113000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Temporal Trends and Hospital Variation in Mineralocorticoid Receptor Antagonist Use in Veterans Discharged With Heart Failure"],"prefix":"10.1161","volume":"4","author":[{"given":"Sandesh","family":"Dev","sequence":"first","affiliation":[{"name":"Phoenix VA Medical Center Phoenix AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Lacy","sequence":"additional","affiliation":[{"name":"Brown University Providence RI"},{"name":"Providence VA Medical Center Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen\u2010Chih","family":"Wu","sequence":"additional","affiliation":[{"name":"Brown University Providence RI"},{"name":"Providence VA Medical Center Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.01.027"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1493"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.934471"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.527549"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.12.009"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.06.024"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.03.007"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.029454"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.06.017"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001063"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2014.01.017"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs033"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040135"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000556"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2013.06.107"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182a3e525"},{"key":"e_1_3_1_23_2","unstructured":"U.S. Department of Veterans Affairs: Veterans Health Administration . Available at: http:\/\/www.Va.Gov\/health\/aboutvha.Asp.2014. Accessed December 10 2014."},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001300"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.115.002268","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T09:59:29Z","timestamp":1715594369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.115.002268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2015,12]]}},"alternative-id":["10.1161\/JAHA.115.002268"],"URL":"https:\/\/doi.org\/10.1161\/jaha.115.002268","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12]]},"assertion":[{"value":"2015-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-10-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-12-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e002268"}}