Vishal Chauhan1, Sandesh Dev2, Michael Pham3, Shoutzu Lin4, Paul Heidenreich3. 1. Department of Medicine, Stanford University, Stanford, CA. Electronic address: vrchauhan41@gmail.com. 2. Phoenix Veterans Affairs Health Care System, Phoenix, AZ. 3. Department of Medicine, Stanford University, Stanford, CA; VA Palo Alto Health Care System, Palo Alto, CA. 4. VA Palo Alto Health Care System, Palo Alto, CA.
Abstract
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) have been shown to reduce morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction but are associated with hyperkalemia. We sought to evaluate the frequency, variation, and predictors associated with serum potassium monitoring in patients with HF initiated on an MRA among facilities in the Veterans Affairs (VA) Health Care System. METHODS: We performed a retrospective cohort analysis of patients with HF across 133 Veterans Affairs facilities from 2003 to 2013 who were given a new prescription of an MRA. The primary outcome was the mean percentage of patients per facility with serum potassium monitoring within 14 days of MRA dispensing. Univariate and covariate analyses were performed to determine factors associated with monitoring. RESULTS: There were 142,880 patients identified with HF initiated on an MRA who met the study inclusion and exclusion criteria. The mean (SD) percentage of patients per facility with serum potassium monitoring within 14 days was 41.6% (standard deviation 8.0%; minimum 18.9%, maximum 56.7%). Facilities with a higher frequency of monitoring were associated with membership in the Council on Teaching Hospitals (n = 70, P < .0001), had academic affiliations (n = 100, P < .0001), and a higher annual volume of patients with HF (≥200 patients, P < .0001). CONCLUSIONS: In a large multicenter national sample of patients with HF receiving a new MRA prescription, the frequency of serum potassium monitoring was below recommended guidelines. Academic facilities and those with a higher volume of patients with HF were associated with an increased frequency of monitoring.
BACKGROUND:Mineralocorticoid receptor antagonists (MRAs) have been shown to reduce morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction but are associated with hyperkalemia. We sought to evaluate the frequency, variation, and predictors associated with serum potassium monitoring in patients with HF initiated on an MRA among facilities in the Veterans Affairs (VA) Health Care System. METHODS: We performed a retrospective cohort analysis of patients with HF across 133 Veterans Affairs facilities from 2003 to 2013 who were given a new prescription of an MRA. The primary outcome was the mean percentage of patients per facility with serum potassium monitoring within 14 days of MRA dispensing. Univariate and covariate analyses were performed to determine factors associated with monitoring. RESULTS: There were 142,880 patients identified with HF initiated on an MRA who met the study inclusion and exclusion criteria. The mean (SD) percentage of patients per facility with serum potassium monitoring within 14 days was 41.6% (standard deviation 8.0%; minimum 18.9%, maximum 56.7%). Facilities with a higher frequency of monitoring were associated with membership in the Council on Teaching Hospitals (n = 70, P < .0001), had academic affiliations (n = 100, P < .0001), and a higher annual volume of patients with HF (≥200 patients, P < .0001). CONCLUSIONS: In a large multicenter national sample of patients with HF receiving a new MRA prescription, the frequency of serum potassium monitoring was below recommended guidelines. Academic facilities and those with a higher volume of patients with HF were associated with an increased frequency of monitoring.
Authors: Erik Nilsson; Pietro De Deco; Marco Trevisan; Rino Bellocco; Bengt Lindholm; Lars H Lund; Josef Coresh; Juan J Carrero Journal: Eur Heart J Qual Care Clin Outcomes Date: 2018-10-01
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-02
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2020-11-02 Impact factor: 24.094