Let's talk about heart failure with preserved ejection fraction and mineralocorticosteroid receptor antagonists: real-world registry data
D Besic, K Gjuras, M Vidjak, F Saler, J Catic, S Manola, I JurinAbstract
Background
Sodium-glucose-cotransporter inhibitors remain the sole pharmaceutical agents that improve survival of patients with heart failure with reduced ejection fraction (HFpEF) [1]. Mineralocorticosteroid inhibitors are frequently used to treat these individuals in real life, however there is insufficient data to support this approach [1].
Objectives
The aim of this study was to examine the association of MRA therapy and outcomes of HFpEF patients.
Methods
We investigated MRA use in a real-world cohort of HFpEF patients diagnosed enrolled in our registry between July 2021 and April 2025. We examined the relationship between MRA treatment and all-cause mortality, heart failure (HF) hospitalizations, and HF-related ER visits, both independently and as a composite outcome. We used logistic regression, correlation, and Kaplan-Meier and Cox proportional hazard ratios for statistical analysis. Age, body mass index (BMI), starting creatinine, hemoglobin, and N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels were all adjusted for.
Results
This registry-based study included 284 patients with a median age of 73 years (IQR 66-78). MRA therapy was prescribed to 54% of patients. After exclusion of patients with incomplete data, there were a total of 40 outcome cases (16%) during the median follow-up period of 365 days (IQR 302-372). MRA therapy correlated negatively with HF-related ER visits (p=.00376). Though the logistic regression model and Cox proportional hazard ratio model were overall significant for the composite outcome (p=.0015 and p=.0035, respectively) and the logistic regression model was significant for the separate outcome of HF-related ER visits (p=.039), after adjusting for age, BMI, creatinine, hemoglobin, and NT-proBNP levels, there was no significant impact of MRA use.
Conclusion
Our research signals that MRA therapy may have a negative impact on HF-related ER visits in HFpEF patients. The effect of MRA use on outcomes in HFpEF patients need more research.