Abstract 13079: Variation in Laboratory Monitoring After Initiation of a Mineralocorticoid Receptor Antagonist in Patients With Heart Failure
Background: Mineralocorticoid Receptor Antagonists (MRA) have been shown to reduce morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction but are associated with hyperkalemia. For this reason the 2009 ACCF/AHA guidelines recommend frequent monitoring of potassium after initiation of an MRA. We sought to evaluate facility-specific characteristics that are associated with adherence to potassium monitoring after MRA initiation.
Methods: Using data from 122 Veterans Affairs facilities from 2003 to 2013, we identified patients with a diagnosis of HF who were started on an MRA. The primary outcome was the mean percentage of patients per facility with serum potassium monitoring within 14 days of MRA initiation.
Results: There were 176,961 patients identified with a diagnosis of HF who survived at least 14 days after initiation of an MRA. The mean percentage of patients with potassium monitoring per facility was 37% with a standard deviation of 7.2%. Facilities with higher rates of monitoring were associated with membership in the Council on Teaching Hospitals (n=70, p = 0.0003), accredited graduate medical education programs (n=94, p = 0.003), academic affiliations (n=100, p = 0.0005), and had cardiologists either on staff or contracted (n=114, p = 0.002). The presence of a heart failure clinic was not clearly associated with a higher rate of monitoring (n=59, p = 0.12). The mean incidence of hospitalization for hyperkalemia at 90 days across all facilities was 0.2%.
Conclusions: In the VA Health System, there was significant variation between facilities with regard to serum potassium monitoring after initiation of an MRA for patients with heart failure. Those facilities that perform more monitoring tend to have stronger academic affiliations and medical training programs. These findings may have implications for efforts to improve the safety of MRAs started on patients with HF.
Author Disclosures: V.R. Chauhan: None. S. Dev: None. M. Pham: None. S. Lin: None. P. Heidenreich: None.
- © 2014 by American Heart Association, Inc.