TY - JOUR
T1 - Association Between Mineralocorticoid Receptor Antagonist Use With Worsening Renal Function and Prognosis in Patients With Acute Heart Failure
AU - Fujimoto, Yudai
AU - Shiraishi, Yasuyuki
AU - Nogi, Kazutaka
AU - Kohsaka, Shun
AU - Kohno, Takashi
AU - Kitamura, Mitsunobu
AU - Nagatomo, Yuji
AU - Ueda, Tomoya
AU - Nogi, Maki
AU - Ishihara, Satomi
AU - Nakada, Yasuki
AU - Kawakami, Rika
AU - Kitai, Takeshi
AU - Oishi, Shogo
AU - Akiyama, Eiichi
AU - Suzuki, Satoshi
AU - Yamamoto, Masayoshi
AU - Kida, Keisuke
AU - Okumura, Takahiro
AU - Yoshikawa, Tsutomu
AU - Saito, Yoshihiko
AU - Matsue, Yuya
N1 - Publisher Copyright:
© 2025 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
PY - 2025/7/3
Y1 - 2025/7/3
N2 - BACKGROUND: Prognostic implications of mineralocorticoid receptor antagonist (MRA) initiation in the context of worsening renal function (WRF) in patients with acute heart failure (AHF) remain unknown. METHODS: This was a post hoc analysis using data from Japanese AHF registries (NARA-HF [Nara Registry and Analyses for Heart Failure], WET-HF [West Tokyo Heart Failure], REALITY-AHF [Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure]). MRA-naïve patients at baseline were included, comprising 1632 patients with HF with reduced ejection fraction (HFrEF) and 2407 with heart failure with mildly reduced or preserved ejection fraction (HFmr/ pEF). They were divided into 3 groups: MRA initiated without WRF (HFrEF, n=590; HFmr/pEF, n=572), MRA initiated with WRF (HFrEF, n=74; HFmr/pEF, n=100), and no MRA initiation (HFrEF, n=968; HFmr/pEF, n=1735). WRF was defined as a 0.3 mg/dL increase from admission to discharge. The composite of death or HF hospitalization after discharge was assessed. RESULTS: During the 1-year follow-up, 369 and 593 events occurred in patients with HFrEF and HFmr/pEF, respectively. Overall, MRA initiation during hospitalization of AHF was independently associated with better prognosis (hazard ratio [HR], 0.81), mainly driven by HF hospitalization. Among patients with HFrEF, the groups with MRA with and without WRF showed a lower incidence of the outcome than the no-MRA group, even after adjusting for risk factors (HR, 0.75 and 0.49, respectively). Among patients with HFmr/pEF, MRA initiation without WRF was independently associated with better prognosis (HR, 0.78), but MRA initiation with WRF was not. CONCLUSIONS: Initiating an MRA during AHF hospitalization was associated with better postdischarge outcomes in HFrEF, irrespective of creatinine elevation, whereas no such consistent association was observed in HFmr/pEF.
AB - BACKGROUND: Prognostic implications of mineralocorticoid receptor antagonist (MRA) initiation in the context of worsening renal function (WRF) in patients with acute heart failure (AHF) remain unknown. METHODS: This was a post hoc analysis using data from Japanese AHF registries (NARA-HF [Nara Registry and Analyses for Heart Failure], WET-HF [West Tokyo Heart Failure], REALITY-AHF [Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure]). MRA-naïve patients at baseline were included, comprising 1632 patients with HF with reduced ejection fraction (HFrEF) and 2407 with heart failure with mildly reduced or preserved ejection fraction (HFmr/ pEF). They were divided into 3 groups: MRA initiated without WRF (HFrEF, n=590; HFmr/pEF, n=572), MRA initiated with WRF (HFrEF, n=74; HFmr/pEF, n=100), and no MRA initiation (HFrEF, n=968; HFmr/pEF, n=1735). WRF was defined as a 0.3 mg/dL increase from admission to discharge. The composite of death or HF hospitalization after discharge was assessed. RESULTS: During the 1-year follow-up, 369 and 593 events occurred in patients with HFrEF and HFmr/pEF, respectively. Overall, MRA initiation during hospitalization of AHF was independently associated with better prognosis (hazard ratio [HR], 0.81), mainly driven by HF hospitalization. Among patients with HFrEF, the groups with MRA with and without WRF showed a lower incidence of the outcome than the no-MRA group, even after adjusting for risk factors (HR, 0.75 and 0.49, respectively). Among patients with HFmr/pEF, MRA initiation without WRF was independently associated with better prognosis (HR, 0.78), but MRA initiation with WRF was not. CONCLUSIONS: Initiating an MRA during AHF hospitalization was associated with better postdischarge outcomes in HFrEF, irrespective of creatinine elevation, whereas no such consistent association was observed in HFmr/pEF.
KW - MRA
KW - WRF
KW - acute heart failure
KW - prognosis
UR - https://www.scopus.com/pages/publications/105011878924
UR - https://www.scopus.com/pages/publications/105011878924#tab=citedBy
U2 - 10.1161/JAHA.124.040252
DO - 10.1161/JAHA.124.040252
M3 - Article
C2 - 40611480
AN - SCOPUS:105011878924
SN - 2047-9980
VL - 14
SP - 1
EP - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 14
ER -