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Bring a large pot of water to a boil. Cook pasta according to package directions; drain.
Meanwhile, in a large skillet add the olive oil then cook and crumble the sausage and red pepper flakes over medium-high heat until cooked through and browned.
Add onion and garlic. Cook until onion is tender.
Add the tomatoes and heavy cream. Simmer until the mixture thickens, about 10 minutes.
Add the spinach and cook an additional 3 minutes.
Add the cooked pasta to the sauce. Sprinkle with parsley, if desired.