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Association of mineralocorticoid receptor antagonist use and in-hospital outcomes in patients with acute heart failure

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Abstract

Mineralocorticoid receptor antagonists (MRAs) constitute a beneficial therapy in chronic heart failure, but their use in the acute heart failure (AHF) setting remains rather unexplored. To assess the effect of MRAs administered during hospitalization on in-hospital outcomes of patients with AHF, we performed a post-hoc analysis of the Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF). Patients of the original study cohort (n = 4953) were categorized according to in-hospital MRA treatment status as MRA-treated (n = 1439) and untreated (n = 3514) subjects. Nearest-neighbor propensity score with 1:1 matching yielded a subsample of pairs of MRA-treated and MRA-untreated patients (n = 1003 in each treatment group) that were balanced in an extensive list of baseline characteristics. In-hospital mortality between MRA-treated and untreated patients were assessed by Cox regression analysis before and after adjustment for known prognostic factors and other concomitantly administered intravenous and oral HF specific therapies. In the matched cohort, in-hospital mortality was 4.2 vs 10.8% in MRA-treated vs untreated patients. Treatment with MRAs was associated with a reduction of in-hospital mortality [HR 0.372 (95% CI, 0.261–0.532), p < 0.001]. This association remained significant after adjustment for known prognostic factors and co-administered intravenous and oral HF therapies [HR: 0.618 (95% CI, 0.383–0.995), p = 0.048]. In conclusion, MRA therapy administered during hospitalization for AHF was associated with reduced in-hospital mortality. The role of MRAs in AHF deserves further examination in adequately powered randomized controlled studies.

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Authors and Affiliations

  1. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece

    Vasiliki Bistola, Panagiotis Simitsis, Dimitrios Farmakis, Ignatios Ikonomidis, Georgios Bakosis, Erifili Hatziagelaki, John Lekakis & John Parissis

  2. Department of Cardiology, Larissa University Hospital, Larissa, Greece

    Filippos Triposkiadis

  3. Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Alexandre Mebazaa

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  1. Vasiliki Bistola
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  2. Panagiotis Simitsis
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  3. Dimitrios Farmakis
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  4. Ignatios Ikonomidis
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  9. Alexandre Mebazaa
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Correspondence to Vasiliki Bistola.

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VB reports honoraria from Novartis and Servier. DF reports honoraria from Servier and Novartis and an educational grant from Novartis. FT reports honoraria from Servier, Novartis, and Bayer. AM reports honoraria from Abbott USA and Orion Pharma. JP reports honoraria from Servier, Novartis, and Orion Pharma.

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Bistola, V., Simitsis, P., Farmakis, D. et al. Association of mineralocorticoid receptor antagonist use and in-hospital outcomes in patients with acute heart failure. Clin Res Cardiol 107, 76–86 (2018). https://doi.org/10.1007/s00392-017-1161-7

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  • DOI: https://doi.org/10.1007/s00392-017-1161-7

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