title: National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011.
abstract: BACKGROUND
  Spironolactone, the only aldosterone antagonist available in China, improves outcomes in acute myocardial infarction (AMI) among patients with systolic dysfunction and either diabetes or heart failure (HF). However, national practice patterns in the use of spironolactone in China are unknown.
  
  
  RESULTS
  From a nationally representative sample of AMI patients from in 2001, 2006, and 2011, we identified 6906 patients with either diabetes or HF and classified them into 1 of 4 groups according to their eligibility for spironolactone-"ideal"(left ventricular ejection fraction [LVEF] ≤40% and without contraindications), "contraindicated," "not indicated" (neither ideal nor contraindicated), and "unknown indications" (LVEF unmeasured)-to determine how frequently patient eligibility for this drug is assessed in the hospital, how it is used in several groups, and to identify factors associated with the use in these groups. From 2001 to 2011, the proportion of patients whose eligibility for spironolactone was not assessed decreased (66.9% in 2001 to 32.8% in 2011). Spironolactone use significantly increased among ideal patients over this period (28.6% to 72.4%; P<0.001 for trend), but also in contraindicated patients (11.4% to 27.5%; P=0.002 for trend) and in other patients groups (not indicated: 27.5% to 38.3%; unknown indications: 21.3% to 35.1%; both P<0.01 for trend). In all 4 groups, patients presenting with HF on admission were more likely to receive spironolactone.
  
  
  CONCLUSIONS
  Although the appropriate use of spironolactone and assessment of eligibility increased in China over the past decade, there remains marked opportunities for improvement.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov Unique identifier: NCT01624883.
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.G., J.L., Q.W., X.L., L.J.).
authors.forename: Wenchi
authors.initials: W
authors.lastname: Guan
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M., N.D., J.S.R., N.R.D., H.M.K.).
authors.forename: Karthik
authors.initials: K
authors.lastname: Murugiah
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M., N.D., J.S.R., N.R.D., H.M.K.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Downing
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.G., J.L., Q.W., X.L., L.J.).
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.G., J.L., Q.W., X.L., L.J.).
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M., N.D., J.S.R., N.R.D., H.M.K.) Section of General Internal Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.) Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (J.S.R., H.M.K.).
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M., N.D., J.S.R., N.R.D., H.M.K.) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.R.D.).
authors.forename: Nihar R
authors.initials: NR
authors.lastname: Desai
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Saint Luke's Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO (J.A.S.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.G., J.L., Q.W., X.L., L.J.).
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M., N.D., J.S.R., N.R.D., H.M.K.) Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.) Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (J.S.R., H.M.K.).
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.G., J.L., Q.W., X.L., L.J.).
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy*; D018802:Patient-Centered Care / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013148:Spironolactone / Q000627:therapeutic use*; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: acute myocardial infarction; quality of care; spironolactone