Discharge Use of Mineralocorticoid Receptor Antagonists and Long-Term Outcomes in HFpEF

To examine whether mineralocorticoid receptor antagonist (MRA) use at discharge after hospitalization for acute decompensated heart failure (ADHF) with preserved ejection fraction is associated with long-term clinical outcomes.

We conducted a single-center retrospective study of adults hospitalized with ADHF in 2015. Patients with left ventricular ejection fraction ≥50% who were discharged alive were included (time zero at discharge). Exposure was MRA (spironolactone or eplerenone) prescribed at discharge. The primary endpoint was time to first occurrence of all-cause death or rehospitalization for heart failure (HF); secondary endpoints were each component.

Among 194 patients, 93 (47.9%) received an MRA at discharge. Median follow-up was 3.5 years (IQR, 1.4-5.1). The 3-year cumulative incidence of the primary composite was lower with MRA than without MRA (50.5% vs 72.2%; log-rank p = 0.02). The 3-year cumulative incidences of all-cause death and HF rehospitalization were numerically lower with MRA (31.1% vs 44.5%, p = 0.055; and 31.1% vs 44.5%, p = 0.09, respectively). After multivariable adjustment, MRA use was associated with lower hazard of the primary composite [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.38-0.81; p = 0.002], all-cause death (HR 0.58, 95% CI 0.36-0.92; p = 0.02), and HF rehospitalization (HR 0.56, 95% CI 0.34-0.91; p = 0.02).

In patients with preserved ejection fraction discharged after ADHF, MRA use at discharge was associated with a lower hazard of the composite of all-cause death or HF rehospitalization.