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Mineralocorticoid receptor antagonists may reduce HF hospitalization
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Among patients with acute decompensated HF, prescription of a mineralocorticoid receptor antagonist at discharge conferred reduced risk for HF hospitalization but not death, researchers reported.
Hidenori Yaku, MD, from the department of cardiovascular medicine at Kyoto University Graduate School of Medicine in Japan, and colleagues conducted a propensity-score matched analysis of 2,068 patients (median age, 80 years; 45% women) from the Kyoto Congestive Heart Failure registry of patients admitted for acute decompensated HF between October 2014 and March 2016. Half of the patients were prescribed a mineralocorticoid receptor antagonist (MRA) at discharge and the other half were not.
The primary outcome of all-cause death or HF hospitalization was lower in the MRA group (28.4% vs. 33.9%; HR = 0.81; 95% CI, 0.7-0.93), according to the researchers.
HF hospitalization rates at 1 year strongly favored the MRA group (18.7% vs. 24.8%; HR = 0.7; 95% CI, 0.6-0.86), but all-cause death at 1 year was similar between the groups (MRA users, 15.6%; nonusers,15.8%; HR = 0.98; 95% CI, 0.82-1.18), Yaku and colleagues wrote.
In addition, there was no significant difference between the groups in all-cause hospitalization at 1 year (users, 35.3%; nonusers, 38.2%; HR = 0.88; 95% CI, 0.77-1.01), according to the researchers.
In patients with HF with reduced ejection fraction, defined as less than 40%, there was no difference between the groups in the primary outcome at 1 year (users, 34.7%; nonusers, 33.7%; HR = 0.87; 95% CI, 0.78-1.21), but in patients with HF with preserved ejection fraction, the primary outcome favored MRA users at 1 year (users, 26.8%; nonusers, 33.7%; HR = 0.78; 95% CI, 0.66-0.93), Yaku and colleagues wrote.
“Considering no differences in mortality or overall rate of hospitalization, MRA use may be associated with minimal, if any, clinical net advantages,” the researchers wrote. “Our additional analyses suggested the potential value of MRA use for patients with HFpEF. Exploratory studies to identify the patient groups that find MRA use advantageous are needed and should be confirmed by [randomized controlled trials] in patients hospitalized for [acute decompensated] HF.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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