{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:49:01Z","timestamp":1791643741101,"version":"4.3.4"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,3,9]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Mineralocorticoid receptor antagonists (\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              s) are the most underutilized pharmacotherapy for heart failure. Minimal data are available on the barriers to\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              adoption from the perspective of prescribing clinicians.\n            <\/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              A mixed\u2010methods study consisting of a survey (n=50), focus groups (n=39), interviews (n=6) with clinicians at a single\n              <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>\n              Department of Veterans Affairs medical center served to ascertain barriers to optimal use of\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              s. Participants were drawn from 6 groups: cardiology providers, cardiology fellows, hospitalists, clinical pharmacists, internal medicine residents, and primary care providers. Qualitative data were iteratively coded with qualitative data analysis software. The survey response rate was 17.3%. Overall, 51% of survey respondents were unfamiliar with eplerenone, and 6% were unfamiliar with spironolactone. In addition, 30% of respondents reported that they would order a laboratory test &gt;2\u00a0weeks after a new\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              prescription, although that is beyond the guideline recommendation. Most providers correctly identified New York Heart Association class 3 and 4 patients as\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              eligible, but only 42% identified class 2 patients as\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              eligible. Through analysis of focus groups, we identified 8 barriers to\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              use in 3 categories: patient\u2010based barriers (concerns about polypharmacy and comorbidities, adverse effects, perceived patient nonadherence), provider\u2010based barriers (unclear roles and responsibilities, coordination and transitions of care, lack of experience or familiarity with\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              s), and system\u2010based barriers (system overload and provider time constraints, lack of systematic follow\u2010up procedures).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Eight primary barriers to\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              adoption at the provider, patient, and health system levels were identified from the prescriber perspective. These barriers can inform the creation of multilevel interventions that will be required to close the gap in\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              adoption.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.115.002493","type":"journal-article","created":{"date-parts":[[2016,4,1]],"date-time":"2016-04-01T02:31:21Z","timestamp":1459477881000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Barriers to Adoption of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure: A Mixed\u2010Methods Study"],"prefix":"10.1161","volume":"5","author":[{"given":"Sandesh","family":"Dev","sequence":"first","affiliation":[{"name":"Cardiology Section, Phoenix VA Health Care System, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trisha K.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Hugh Downs School of Human Communication, Arizona State University,  Tempe, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dio","family":"Kavalieratos","sequence":"additional","affiliation":[{"name":"Section\u00a0of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Cardiology Section, Palo Alto VA Medical Center, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen\u2010Chih","family":"Wu","sequence":"additional","affiliation":[{"name":"Cardiology Section, Providence VA Medical Center, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn C.","family":"Schwenke","sequence":"additional","affiliation":[{"name":"Research Section, Phoenix VA Health Care System,  Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"Tracy","sequence":"additional","affiliation":[{"name":"Hugh Downs School of Human Communication, Arizona State University,  Tempe, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Pfunter A Wier L Stocks C. Most frequent conditions in U.S. Hospitals 2011. Health Care Cost and Utilization Project (HCUP) Statistical Brief #162. 2013. Available at: http:\/\/www.hcup-us.ahrq.gov\/reports\/statbriefs\/sb162.pdf. Accessed March 26 2016."},{"key":"e_1_3_3_3_2","first-page":"e1002","article-title":"Heart disease and stroke statistics\u20132012 update: a report from the American Heart Association","volume":"125","author":"Roger VL","year":"2012","unstructured":"Roger VL, Go AS, Lloyd\u2010Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics\u20132012 update: a report from the American Heart Association. 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