The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study
BackgroundRandomized clinical trials of spironolactone showed significant mortality reduction in patients with heart failure with reduced ejection fraction. However, its role in acute heart failure syndrome (AHFS) is largely unknown.AimTo investigate the prescription characteristics, efficacy and sa...
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| Format: | Article |
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.791446/full |
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| author | Soo Jin Na Soo Jin Na Jong-Chan Youn Hye Sun Lee Soyoung Jeon Hae-Young Lee Hyun-Jai Cho Jin-Oh Choi Eun-Seok Jeon Sang Eun Lee Min-Seok Kim Jae-Joong Kim Kyung-Kuk Hwang Myeong-Chan Cho Shung Chull Chae Seok-Min Kang Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Byung-Hee Oh Sang Hong Baek |
| author_facet | Soo Jin Na Soo Jin Na Jong-Chan Youn Hye Sun Lee Soyoung Jeon Hae-Young Lee Hyun-Jai Cho Jin-Oh Choi Eun-Seok Jeon Sang Eun Lee Min-Seok Kim Jae-Joong Kim Kyung-Kuk Hwang Myeong-Chan Cho Shung Chull Chae Seok-Min Kang Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Byung-Hee Oh Sang Hong Baek |
| author_sort | Soo Jin Na |
| collection | DOAJ |
| description | BackgroundRandomized clinical trials of spironolactone showed significant mortality reduction in patients with heart failure with reduced ejection fraction. However, its role in acute heart failure syndrome (AHFS) is largely unknown.AimTo investigate the prescription characteristics, efficacy and safety of spironolactone in real-world patients with AHFS.Methods5,136 AHFS patients who survived to hospital discharge using a nationwide prospective registry in Korea were analyzed. The primary efficacy outcome was 3-year all-cause mortality.ResultsSpironolactone was prescribed in 2,402 (46.8%) at discharge: <25 mg in 890 patients (37.1%), ≥25 mg, and <50 mg in 1,154 patients (48.0%), and ≥50 mg in 358 patients (14.9%). Patients treated with spironolactone had a lower proportion of chronic renal failure and renal replacement therapy during hospitalization and had lower serum creatinine level than those who did not. In overall patients, 3-year mortality was not different in both groups (35.9 vs. 34.5%, P = 0.279). The incidence of renal injury and hyperkalemia was 2.2% and 4.3%, respectively, at the first follow-up visit. The treatment effect of spironolactone on mortality was different across subpopulations according to LVEF. The use of spironolactone was associated with a significant reduction in 3-year morality in patients with LVEF ≤ 26% (33.8 vs. 44.3%, P < 0.001; adjusted HR 0.79, 95% CI 0.64–0.97, P = 0.023), but not in patients with LVEF > 26%.ConclusionsAlthough spironolactone was frequently used at lower doses in real-world practice, use of spironolactone significantly reduced 3-year mortality in patients with severely reduced LVEF with acceptable safety profile. However, our findings remain prone to various biases and further prospective randomized controlled studies are needed to confirm these findings. |
| first_indexed | 2024-04-13T00:52:51Z |
| format | Article |
| id | doaj.art-0e2ce873279a457ab44c6165c495d683 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T00:52:51Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-0e2ce873279a457ab44c6165c495d6832022-12-22T03:09:48ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-02-01910.3389/fcvm.2022.791446791446The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort StudySoo Jin Na0Soo Jin Na1Jong-Chan Youn2Hye Sun Lee3Soyoung Jeon4Hae-Young Lee5Hyun-Jai Cho6Jin-Oh Choi7Eun-Seok Jeon8Sang Eun Lee9Min-Seok Kim10Jae-Joong Kim11Kyung-Kuk Hwang12Myeong-Chan Cho13Shung Chull Chae14Seok-Min Kang15Dong-Ju Choi16Byung-Su Yoo17Kye Hun Kim18Byung-Hee Oh19Sang Hong Baek20Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South KoreaDepartment of Medicine, Catholic University Graduate School, Seoul, South KoreaDivision of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, South KoreaBiostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South KoreaBiostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South KoreaDepartment of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South KoreaDepartment of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South KoreaDepartment of Internal Medicine, Kyungpook National University College of Medicine, Daegu, South Korea0Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea3Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, South Korea4Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, South KoreaDivision of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, South KoreaBackgroundRandomized clinical trials of spironolactone showed significant mortality reduction in patients with heart failure with reduced ejection fraction. However, its role in acute heart failure syndrome (AHFS) is largely unknown.AimTo investigate the prescription characteristics, efficacy and safety of spironolactone in real-world patients with AHFS.Methods5,136 AHFS patients who survived to hospital discharge using a nationwide prospective registry in Korea were analyzed. The primary efficacy outcome was 3-year all-cause mortality.ResultsSpironolactone was prescribed in 2,402 (46.8%) at discharge: <25 mg in 890 patients (37.1%), ≥25 mg, and <50 mg in 1,154 patients (48.0%), and ≥50 mg in 358 patients (14.9%). Patients treated with spironolactone had a lower proportion of chronic renal failure and renal replacement therapy during hospitalization and had lower serum creatinine level than those who did not. In overall patients, 3-year mortality was not different in both groups (35.9 vs. 34.5%, P = 0.279). The incidence of renal injury and hyperkalemia was 2.2% and 4.3%, respectively, at the first follow-up visit. The treatment effect of spironolactone on mortality was different across subpopulations according to LVEF. The use of spironolactone was associated with a significant reduction in 3-year morality in patients with LVEF ≤ 26% (33.8 vs. 44.3%, P < 0.001; adjusted HR 0.79, 95% CI 0.64–0.97, P = 0.023), but not in patients with LVEF > 26%.ConclusionsAlthough spironolactone was frequently used at lower doses in real-world practice, use of spironolactone significantly reduced 3-year mortality in patients with severely reduced LVEF with acceptable safety profile. However, our findings remain prone to various biases and further prospective randomized controlled studies are needed to confirm these findings.https://www.frontiersin.org/articles/10.3389/fcvm.2022.791446/fullacute heart failure syndromespironolactonemineralocorticoid receptor antagonistsdrug therapyoutcome |
| spellingShingle | Soo Jin Na Soo Jin Na Jong-Chan Youn Hye Sun Lee Soyoung Jeon Hae-Young Lee Hyun-Jai Cho Jin-Oh Choi Eun-Seok Jeon Sang Eun Lee Min-Seok Kim Jae-Joong Kim Kyung-Kuk Hwang Myeong-Chan Cho Shung Chull Chae Seok-Min Kang Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Byung-Hee Oh Sang Hong Baek The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study Frontiers in Cardiovascular Medicine acute heart failure syndrome spironolactone mineralocorticoid receptor antagonists drug therapy outcome |
| title | The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study |
| title_full | The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study |
| title_fullStr | The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study |
| title_full_unstemmed | The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study |
| title_short | The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study |
| title_sort | prescription characteristics efficacy and safety of spironolactone in real world patients with acute heart failure syndrome a prospective nationwide cohort study |
| topic | acute heart failure syndrome spironolactone mineralocorticoid receptor antagonists drug therapy outcome |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.791446/full |
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