RT Journal Article
A1 Yaku, Hidenori
A1 Kato, Takao
A1 Morimoto, Takeshi
A1 Inuzuka, Yasutaka
A1 Tamaki, Yodo
A1 Ozasa, Neiko
A1 Yamamoto, Erika
A1 Yoshikawa, Yusuke
A1 Kitai, Takeshi
A1 Taniguchi, Ryoji
A1 Iguchi, Moritake
A1 Kato, Masashi
A1 Takahashi, Mamoru
A1 Jinnai, Toshikazu
A1 Ikeda, Tomoyuki
A1 Nagao, Kazuya
A1 Kawai, Takafumi
A1 Komasa, Akihiro
A1 Nishikawa, Ryusuke
A1 Kawase, Yuichi
A1 Morinaga, Takashi
A1 Toyofuku, Mamoru
A1 Seko, Yuta
A1 Furukawa, Yutaka
A1 Nakagawa, Yoshihisa
A1 Ando, Kenji
A1 Kadota, Kazushige
A1 Shizuta, Satoshi
A1 Ono, Koh
A1 Sato, Yukihito
A1 Kuwahara, Koichiro
A1 Kimura, Takeshi
A1 for the KCHF Study Investigators
T1 Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure
JF JAMA Network Open
JO JAMA Netw Open
YR 2019
DO 10.1001/jamanetworkopen.2019.5892
VO 2
IS 6
SP e195892
OP e195892
SN 2574-3805
AB Scarce data are available on the association of mineralocorticoid receptor antagonist (MRA) use with outcomes in acute decompensated heart failure (ADHF).To investigate the association of MRA use with all-cause mortality and hospital readmission in patients with ADHF.This cohort study examines participants enrolled in the Kyoto Congestive Heart Failure (KCHF) registry, a physician-initiated, prospective, multicenter cohort study of consecutive patients admitted for ADHF, between October 1, 2014, and March 31, 2016, into 1 of 19 secondary and tertiary hospitals throughout Japan. To balance the baseline characteristics associated with the selection of MRA use, a propensity score–matched cohort design was used, yielding 2068 patients. Data analysis was conducted from April to August 2018.Prescription of MRA at discharge from the index hospitalization.Composite of all-cause death or heart failure hospitalization after discharge.Among 3717 patients hospitalized for ADHF, 1678 patients (45.1%) had received MRA at discharge and 2039 (54.9%) did not. After propensity score matching, 2068 patients (with a median [interquartile range] age of 80 [72-86] years, and of whom 937 [45.3%] were women) were included. In the matched cohort (n = 1034 in each group), the cumulative 1-year incidence of the primary outcome was statistically significantly lower in the MRA use group than in the no MRA use group (28.4% vs 33.9%; hazard ratio [HR], 0.81; 95% CI, 0.70-0.93; P = .003). Of the components of the primary outcome, the cumulative 1-year incidence of heart failure hospitalization was significantly lower in the MRA use group than in the no MRA use group (18.7% vs 24.8%; HR, 0.70; 95% CI, 0.60-0.86; P < .001), whereas no difference in mortality was found between the 2 groups (15.6% vs 15.8%; HR, 0.98; 95% CI, 0.82-1.18; P = .85). No difference in all-cause hospitalization was observed between the 2 groups (35.3% vs 38.2%; HR, 0.88; 95% CI, 0.77-1.01; P = .07). In additional analyses that stratified by left ventricular ejection fraction, the association of MRA use with the primary outcome was statistically significant in patients with left ventricular ejection fraction of 40% or greater.Use of MRA at discharge from ADHF hospitalization did not appear to be associated with lower mortality but was associated with a lower risk of heart failure readmission. This finding suggests that MRA treatment at discharge may have minimal, if any, clinical advantages.
RD 7/4/2022
UL https://doi.org/10.1001/jamanetworkopen.2019.5892