title: Facility variation and predictors of serum potassium monitoring after initiation of a mineralocorticoid receptor antagonist in patients with heart failure.
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.
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA. Electronic address: vrchauhan41@gmail.com.
authors.forename: Vishal
authors.initials: V
authors.lastname: Chauhan
authors.affiliation: Phoenix Veterans Affairs Health Care System, Phoenix, AZ.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Dev
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA; VA Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pham
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Shoutzu
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA; VA Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Heidenreich
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D011188:Potassium