Temporal Trends and Hospital Variation in Mineralocorticoid Receptor Antagonist Use in Veterans Discharged With Heart Failure

Abstract

Background Despite concerns about mineralocorticoid receptor antagonist therapies (MRAs) underuse and misuse in patients with heart failure, temporal and institutional variations of MRA prescription have not been reported. Methods and Results We studied a national sample of veterans hospitalized for heart failure between 2003 and 2009 and left ventricular ejection fraction 1.2 indicates significant practice‐level variation. Conclusions There was decreasing MRA use between 2003 and 2009 with wide institutional variation in MRA prescription, which suggests opportunities for improvement to stimulate MRA use in ideal candidates while further reducing use in those with contraindications.

Keywords

• appropriateness criteria
• quality of care
• spironolactone
• variation