{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:04:31Z","timestamp":1777352671218,"version":"3.51.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,7,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Guidelines recommend mineralocorticoid receptor antagonist (MRA) use in patients with left ventricular ejection fraction \u226440% following a myocardial infarction plus heart failure or diabetes mellitus, based on mortality benefit in the EPHESUS (Eplerenone Post\u2010Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial. The objective of this study was to evaluate the real\u2010world utilization of MRAs for patients with ST\u2010segment\u2013elevation myocardial infarction (STEMI) with left ventricular dysfunction.<\/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\">The prospective, population\u2010based, Vancouver Coastal Health Authority STEMI database was linked with local outpatient cardiology records from 2007 to 2018. EPHESUS criteria were used to define post\u2010STEMI MRA eligibility (left ventricular ejection fraction \u226440% plus clinical heart failure or diabetes mellitus, and no dialysis\u2010dependent renal dysfunction). The primary outcome was MRA prescription among eligible patients at discharge and the secondary outcome was MRA prescription within 3\u00a0months postdischarge. Of 2691 patients with STEMI, 317 (12%) were MRA eligible, and 70 (22%) eligible patients were prescribed an MRA at discharge. Among eligible patients with no MRA at discharge, 12\/126 (9.5%) with documented postdischarge follow\u2010up were prescribed an MRA within 3\u00a0months. In multivariable analysis, left ventricular ejection fraction (odds ratio [OR], 1.55 per 5% left ventricular ejection fraction decrease; 95% CI, 1.26\u20131.90) and calendar year (OR, 1.23 per year, 95% CI, 1.11\u20131.37) were associated with MRA prescription at discharge. Other prespecified variables were not associated with MRA prescription.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In this contemporary STEMI cohort, only 1 in 4 MRA\u2010eligible patients were prescribed an MRA within 3\u00a0months following hospitalization despite high\u2010quality evidence for use. Novel decision\u2010support tools are required to optimize pharmacotherapy decisions during hospitalization and follow\u2010up to target this gap in post\u2010STEMI care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019167","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T10:12:02Z","timestamp":1625566322000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Predictors of the Use of Mineralocorticoid Receptor Antagonists in Patients With Left Ventricular Dysfunction Post\u2010ST\u2010Segment\u2013Elevation Myocardial Infarction"],"prefix":"10.1161","volume":"10","author":[{"given":"Eric C.","family":"Wong","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine Department of Medicine University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher 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