Mineralocorticoid receptor antagonists ( MRAs ) have been demonstrated to improve outcomes in reduced ejection fraction heart failure ( HFrEF ) patients.
However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia.
A population-based analysis has investigated the long-term effects of treatment with mineralocorticoid receptor antagonists in HFrEF patients.
Data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset were analysed.
Analysis was performed in patients treated ( n = 3163 ) and not-treated ( n = 2883 ) with mineralocorticoid receptor antagonists.
The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation.
At 10 years' follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group ( P less than 0.001 ).
MRA-treated patients had more severe heart failure ( higher NYHA class and lower left ventricular ejection fraction, kidney function, and peak VO2 ).
At a propensity-score-matching analysis performed on 1587 patients, MRA-treated and MRA-untreated patients showed similar study endpoint values.
In conclusion, treatment with mineralocorticoid receptor antagonists does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real-life setting.
A meticulous patient follow-up, as performed in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials. ( Xagena )
Bruno N et al, ESC Heart Fail 2018;5:267-274