MRA initiation during hospitalization tied to improved outcomes in HFrEF

In patients with heart failure with reduced ejection fraction (HFrEF), initiation of a mineralocorticoid receptor antagonist (MRA) appears to result in better postdischarge outcomes, regardless of creatinine elevation, as shown in a study.

Researchers conducted a post hoc analysis using data from the following Japanese acute heart failure registries: Nara Registry and Analyses for Heart Failure, West Tokyo Heart Failure, and Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure.

The analysis included 1,632 patients with HFrEF and 2,407 with heart failure with mildly reduced or preserved ejection fraction (HFmr/pEF). Patients who were naïve to MRA at baseline were included.

The study population was grouped into three, according to MRA initiation: MRA initiated without worsening renal function (WRF) (HFrEF, n=590; HFmr/pEF, n=572), MRA initiated with WRF (HFrEF, n=74; HFmr/pEF, n=100), and no MRA initiation (HFrEF, n=968; HFmr/pEF, n=1,735). WRF was defined as at least a 0.3-mg/dL increase in creatinine from admission to discharge. The primary endpoint was the composite of death or HF hospitalization after discharge.

Over a 1-year follow-up, a total of 369 and 593 primary endpoint events occurred among patients with HFrEF and HFmr/pEF, respectively. MRA initiation was associated with better prognosis (hazard ratio [HR], 0.81, 95 percent confidence interval [CI], 0.70–0.94; p=0.006).

In the HFrEF cohort, patients who were initiated on MRA with or without WRF had a lower risk of the primary endpoint compared with those who did not receive MRA (HR, 0.75, 95 percent CI, 0.59–0.96; p=0.023 and HR, 0.49, 95 percent CI, 0.28–0.88; p=0.018, respectively).

In the HFmr/pEF cohort, MRA initiation without WRF was associated with better prognosis (HR, 0.78, 95 percent CI, 0.63–0.97; p=0.024), while MRA initiation with WRF was not (HR, 1.38, 95 percent CI, 0.95–2.01; p=0.088).