{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:58:58Z","timestamp":1789473538621,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Although aldosterone antagonists improve outcomes in select individuals with heart failure and reduced ejection fraction, studies in the United States have raised concerns about underuse and overuse. Variations in the prescription of aldosterone antagonist in China are unknown.<\/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              In the multicenter, hospital\u2010based, retrospective China PEACE (China Patient\u2010Centered Evaluative Assessment of Cardiac Events) study, we identified a nationally representative cohort of admissions for heart failure in a nationally representative sample of Chinese hospitals in 2015. Patients were classified into 1 of 3 groups according to their eligibility for spironolactone\u2014\u201cideal\u201d (left ventricular ejection fraction &lt;40% and without contraindications), \u201ccontraindicated\u201d (a documented contraindication, irrespective of left ventricular ejection fraction), and \u201cuncertain\u2010benefit\u201d (all others). We measured hospital variation of spironolactone prescriptions at discharge in the \u201cideal\u201d and \u201ccontraindicated\u201d group and calculated the median odds ratio (MOR), a measure of institution\u2010level variation for 2 individuals with similar characteristics discharged at 2 randomly selected hospitals. Hospital characteristics associated with spironolactone use were identified using multivariable linear regression model. Among 1222 ideal patients from 97 hospitals, the median rate of spironolactone prescription was 78.6% (interquartile range [IQR], 42.8%\u201389.6% [range, 0%\u2013100%], MOR, 3.4 [95% CI, 2.7\u20134.0]) at discharge. Among 900 contraindicated patients from 83 hospitals, the median rate of spironolactone prescription was 30.0% (IQR, 9.1%\u201350.0% [range, 0%\u2013100%], MOR, 3.1 [95% CI, 2.4\u20133.9]) at discharge. Hospitals with independent departments of cardiology and located in Eastern China were associated with a 38.0% (95% CI, 18.7\u201357.3;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and a 14.6% (95% CI, 2.3%\u201326.9%;\n              <jats:italic>P<\/jats:italic>\n              =0.020) higher rate of spironolactone use for ideal patients.\n            <\/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 national study of hospitals in China, the use of spironolactone among ideal patients and the inappropriate use of spironolactone among patients with contraindications was substantial, with rates that varied markedly by institution.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02877914.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026300","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T09:47:04Z","timestamp":1664444824000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China\u2014The China PEACE Retrospective Heart Failure Study"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8485-6583","authenticated-orcid":false,"given":"Yuan","family":"Yu","sequence":"first","affiliation":[{"name":"National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenchi","family":"Guan","sequence":"additional","affiliation":[{"name":"National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"Ascension Health St Louis MO"},{"name":"Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5386-4975","authenticated-orcid":false,"given":"Bin","family":"Wang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangda","family":"He","sequence":"additional","affiliation":[{"name":"National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2839-2611","authenticated-orcid":false,"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Kansas City MO"},{"name":"Saint Luke\u2019s Mid America Heart Institute Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-2169","authenticated-orcid":false,"given":"Yuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, and Department of Internal Medicine Yale University School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-127X","authenticated-orcid":false,"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation Yale\u2010New Haven Hospital New Haven CT"},{"name":"Department of Health Policy and Management Yale School of Public Health New Haven CT"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-8638","authenticated-orcid":false,"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"National Clinical Research Center of Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People\u2019s Republic of China"},{"name":"Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen P. 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