{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:49:06Z","timestamp":1791643746691,"version":"4.3.4"},"reference-count":36,"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":[[2017,12,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Perceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              ) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease.\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              Using clinical registry data linked to Medicare claims, we analyzed patients hospitalized with heart failure between 2005 and 2013 with a history of diabetes mellitus or chronic kidney disease. We stratified patients by\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              use at discharge. We used inverse probability\u2013weighted proportional hazards models to assess associations between\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              therapy and 30\u2010day, 1\u2010year, and 3\u2010year mortality, all\u2010cause readmission, and readmission for heart failure, hyperkalemia, and acute renal insufficiency. We performed interaction analyses for differential effects on 3\u2010year outcomes for reduced, borderline, and preserved ejection fraction. Of 16\u00a0848 patients, 12.3% received\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              therapy at discharge. Higher serum creatinine was associated with lower odds of\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              use (odds ratio, 0.66; 95% confidence interval, 0.61\u20130.71); serum potassium was not (odds ratio, 1.00; 95% confidence interval, 0.90\u20131.11). There was no mortality difference between groups.\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              therapy was associated with greater risks of readmission for hyperkalemia and acute renal insufficiency and lower risks of long\u2010term all\u2010cause readmission. Patients on\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              therapy with borderline or preserved ejection fraction had greater risks of readmission for hyperkalemia (\n              <jats:italic>P<\/jats:italic>\n              =0.02) and acute renal insufficiency (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001); patients with reduced ejection fraction did not.\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              Among patients with heart failure and diabetes mellitus or chronic kidney disease,\n              <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>\n              use was associated with lower risk of all\u2010cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.006540","type":"journal-article","created":{"date-parts":[[2017,12,24]],"date-time":"2017-12-24T01:10:33Z","timestamp":1514077833000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease"],"prefix":"10.1161","volume":"6","author":[{"given":"Lauren B.","family":"Cooper","sequence":"first","affiliation":[{"name":"Heart Failure and Transplant Program, Inova Heart &amp; Vascular Institute, Inova Fairfax Hospital, Falls Church, VA"},{"name":"Department of Medicine, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Lippmann","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Greiner","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"},{"name":"Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson\u2010UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian F.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, NC"},{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0b013e31829e8776"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2015.0356"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.9.2106"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.10.040"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200109203451215"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00240106"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284427"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5001854"},{"key":"e_1_3_5_11_2","first-page":"Cd007004","article-title":"Aldosterone antagonists for preventing the progression of chronic kidney disease","volume":"4","author":"Bolignano D","year":"2014","unstructured":"Bolignano D, Palmer SC, Navaneethan SD, Strippoli GF. 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