Mineralocorticoid receptor antagonists for heart failure: a real life observational study

Published: 17 September 2019| Version 2 | DOI: 10.17632/2rhzf6zwz4.2
Noemi Bruno, Gianfranco Sinagra, Stefania Paolillo, Alice Bonomi, Ugo Corrà, Massimo Piepoli, Fabrizio Veglia, Elisabetta Salvioni, Rocco Lagioia, Marco Metra, Giuseppe Limongelli, Gaia Cattadori, Angela B. Scardovi, Valentina Carubelli, Domenico Scrutinio, Roberto Badagliacca, Marco Guazzi, Rosa Raimondo, Piero Gentile, Damiano Magrì, Michele Correale, Gianfranco Parati, Federica Re, Mariantonietta Cicoira, Maria Frigerio, Maurizio Bussotti, Carlo Vignati, Fabrizio Oliva, Alessandro Mezzani, Andrea Di Lenarda, Claudio Passino, Susanna Sciomer, Giuseppe Pacileo, Roberto Ricci, Mauro Contini, Anna Apostolo, Pietro Palermo, Massimo Mapelli, Cosimo Carriere, Francesco Clemenza, Simone Binno, Romualdo Belardinelli, Carolina Lombardi, Pasquale Perrone Filardi, Michele Emdin, Piergiuseppe Agostoni


Aims. Mineralocorticoid receptor antagonists (MRA) have been demonstrated to improve outcomes in reduced ejection fraction heart failure patients (HFrEF). However, MRA added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients. Methods and Results. We analyzed 6046 patients data included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score data-set. Analysis was performed in patients treated (n=3163) and not treated (n=2883) with MRA. Study endpoint was composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation. Ten years survival was analyzed through Kaplan Meier, compared by Log-Rank test and propensity score matching. At 10 years follow-up MRA not treated group had significantly lower number of events than MRA treated group (p<0.001).MRA treated patients had more severe HF (higher NYHA class and lower left ventricular ejection fraction, kidney function and peakVO2). At propensity score matching analysis performed on 1587 patients, MRA treated and not treated patients showed similar study endpoint values. Conclusion. In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, in a real life setting. A meticulous patients follow-up, as done in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials.



Universita degli Studi di Milano


Mineralocorticoid, Heart Failure, Prognosis of Heart Failure