Eur J Heart Fail. 2023 Jul 18. doi: 10.1002/ejhf.2975. Online ahead of print.
AIMS: Heart failure (HF) guidelines recommend initiation and optimization of guideline directed medical therapy (GDMT), including mineralocorticoid receptor antagonists (MRAs), before hospital discharge. However, scientific evidence for this recommendation is lacking. Our objective was to determine whether initiation of MRA prior to hospital discharge is associated with improved outcomes.
METHODS AND RESULTS: We performed a secondary analysis of 6197 patients enrolled in the RELAXin in AHF-2 (acute HF) study. Patients were divided into 4 groups according to MRA therapy at baseline and discharge. At baseline 30% of patients received MRA therapy, which increased to 50% of patients at discharge. In-hospital initiation of an MRA was observed in 1690 (27%) patients, 1438 (23%) patients remained on MRA therapy, 418 (7%) patients discontinued MRA treatment, and 2651 (42%) patients did not receive an MRA during hospital stay. Compared with patients who did not receive MRA therapy, in-hospital initiation of a MRA was independently associated with lower risks of mortality (multivariable hazard ratio (HR) 0.76 (0.60-0.96), p = 0.02), cardiovascular (CV) death (HR 0.77 (0.59-1.01), p = 0.06), hospitalization for HF or renal failure (HR 0.72 (0.60-0.86), p = 0.0003) and the composite endpoint of CV death and/or rehospitalization for HF or renal failure (HR 0.71 (0.61-0.83), p < 0.0001) at 180 days. These results were independent of baseline left ventricular ejection fraction.
CONCLUSION: In patients hospitalized for acute HF, in-hospital initiation of an MRA was associated with improved post-discharge outcomes, independent of LVEF and other potential confounders. This article is protected by copyright. All rights reserved.