Association of Spironolactone Use with All-Cause Mortality in Heart Failure: A Propensity Scored Cohort Study.
Circ Heart Fail. 2013 Feb 5;
Authors: Lund LH, Svennblad B, Melhus H, Hallberg P, Dahlström U, Edner M
Abstract
BACKGROUND: -In three randomized controlled trials in heart failure (HF), mineralocorticoid receptor antagonists reduced mortality. The net benefit from randomized controlled trials may not be generalizable, and eplerenone was, but spironolactone was not studied in mild heart failure. We tested the hypothesis that spironolactone is associated with reduced mortality also in a broad un-selected contemporary population with heart failure and reduced ejection fraction (EF), in particular New York Heart Association (NYHA) I-II. METHODS AND RESULTS: -We prospectively studied 18,852 patients (age 71±12 years, 28% women) with NYHA I-IV and EF < 40% who were registered in the Swedish Heart Failure Registry between 2000 and 2012 and who were (n=6,551) or were not (n=12,301) treated with spironolactone. We derived propensity scores for spironolactone treatment based on 41 covariates. We assessed survival by Cox regression with adjustment for propensity scores and with matching based on propensity score. We performed sensitivity and residual confounding analyses and analyzed the NYHA I-II and III-IV subgroups separately. One-year survival was 83% vs. 84% in treated vs. un-treated patients (p<0.001). After adjustment for propensity scores, the hazard ratio (HR) for spironolactone was 1.05 (95% CI, 1.00-1.11, p=0.054). Spironolactone interacted with NYHA (p<0.001). In the NYHA I-II sub-group, after adjustment for propensity scores, the HR for spironolactone was 1.11 (95% CI, 1.02-1.21, p=0.019). CONCLUSIONS: -In an un-selected contemporary population of HF with reduced EF, spironolactone was not associated with reduced mortality. The net benefits of spironolactone may be lower outside the clinical trial setting and in milder HF.
PMID: 23386667 [PubMed - as supplied by publisher]