Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction

Abstract

Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). Methods and results We analysed HFmrEF (left ventricular EF 40–49%) patients enrolled in the Japanese Cardiac Registry of Heart Failure in Cardiology, which prospectively studied the clinical characteristics, treatments, and long‐term outcomes of patients hospitalized due to HF. Patients were divided into two groups according to the use of spironolactone at discharge. The primary outcome was a composite of all‐cause death or HF rehospitalization. A total of 457 patients had HFmrEF. The mean age was 69.3 years and 286 (62.6%) were male. Among them, spironolactone was prescribed at discharge in 158 patients (34.6%). Chronic kidney disease (7.6% vs. 16.8%, P = 0.007) was less prevalent and loop diuretics (89.2% vs. 70.2%, P < 0.001) were more often prescribed in patients with spironolactone. During a mean follow‐up of 2.2 years, patients with spironolactone had a lower incidence rate of the primary outcome than those without it (171.5 vs. 278.8 primary outcome per 1000 patient‐years, incidence rate ratio 0.61, 95% confidence interval 0.44–0.86; P = 0.004). After multivariable adjustment, spironolactone use at discharge was associated with a significant reduction in the composite of all‐cause death or HF rehospitalization (adjusted hazard ratio 0.63, 95% confidence interval 0.44–0.90, P = 0.010). Conclusions Among patients with HF hospitalized for HFmrEF, spironolactone use at discharge was associated with better long‐term outcomes.

Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence

“…In line with these findings, the Japanese Cardiac Registry of HF reported that spironolactone at the time of discharge in patients with HFmrEF was associated with lower rates of the composite of all-cause death or HF rehospitalization over 2.2 years [ 30 ]. In a retrospective study from China, the one-year rate of death or HF rehospitalization was lower among patients receiving spironolactone 50 or 25 mg daily compared to untreated patients (21.3% vs. 34.5%, p = 0.014), without a difference between the high and low spironolactone dose groups (21.8% vs. 20.7%, respectively, p = 0.861) [ 28 ].…”

Clinical characteristics and outcomes of black African heart failure patients with preserved, mid‐range, and reduced ejection fraction: a post hoc analysis of the THESUS‐HF registry

“…The mean age of HFmrEF in this study was 54.6 years, lower than reported in developed countries. 14,22 In this report, the mean ages across all EF categories were lower than the mean age across corresponding EF categories in high-income countries. 14 This may reflect differences in HF aetiologies between low-income and high-income countries.…”

“…The impact of MRA on outcome in HFmrEF is less well known. A recent study showed that the MRA spironolactone was independently associated with a significant reduction in mortality and HF rehospitalization in HFmrEF 22 . Although patients with HFpEF in our study had lower heart rates, they were more likely to be prescribed beta‐blockers.…”

“…A recent study showed that the MRA spironolactone was independently associated with a significant reduction in mortality and HF rehospitalization in HFmrEF. 22 Although patients with HFpEF in our study had lower heart rates, they were more likely to be prescribed beta-blockers. This finding is in contrast with the guideline suggested treatment for patients with HF where the use of beta-blockers is mandated in patients with HFrEF regardless of their EF.…”

Heart Failure With Mid-range or Recovered Ejection Fraction: Differential Determinants of Transition

“…[ 31 ] In another recent study, spironolactone use at discharge after an acute HF episode was associated with better long-term outcomes. [ 32 ] A retrospective analysis of the Digitalis Investigation Group (DIG) suggested a slightly higher decrease in CV death and HF hospitalisation in HFmrEF than HFpEF patients. [ 33 ]…”