Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients
Abstract Aims Guideline‐directed medical therapy (GDMT) including beta‐blockers and renin–angiotensin system inhibitors is shown to reduce mortality risk in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is little evidence about the efficacy of...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12862 |
| _version_ | 1831794066648465408 |
|---|---|
| author | Takuro Abe Kentaro Jujo Motoko Kametani Yuichiro Minami Noritoshi Fukushima Katsumi Saito Nobuhisa Hagiwara |
| author_facet | Takuro Abe Kentaro Jujo Motoko Kametani Yuichiro Minami Noritoshi Fukushima Katsumi Saito Nobuhisa Hagiwara |
| author_sort | Takuro Abe |
| collection | DOAJ |
| description | Abstract Aims Guideline‐directed medical therapy (GDMT) including beta‐blockers and renin–angiotensin system inhibitors is shown to reduce mortality risk in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is little evidence about the efficacy of additional administration of mineralocorticoid receptor antagonists (MRAs) with GDMT in patients ≥80 years presenting with HF. We aimed to investigate the prognostic impact of GDMT with MRA in relation to the age of patients with HF. Methods and results This observational study included patients admitted for HF with reduced LVEF who were discharged alive; among them, 224 patients were ≥80 years, and 661 patients were <80 years. Both populations were divided into three groups depending on whether they received GDMT with or without MRA or single/no GDMT drugs (GDMT+MRA+, GDMT+MRA−, or non‐GDMT, respectively). The primary endpoint was all‐cause mortality. In patients ≥80 years, all‐cause mortality was the lowest in the GDMT+MRA+ group (log‐rank trend, P = 0.034), and no significant differences were observed between the GDMT+MRA− and non‐GDMT groups. Multivariate Cox regression analysis revealed that GDMT+MRA+ was superior to GDMT+MRA−, even after adjusting for parameters at discharge (hazard ratio: 0.32, 95% confidence interval: 0.11–0.99). In patients <80 years, GDMT reduced all‐cause mortality; however, additional MRA was not associated with an improved outcome. Conclusions The results of this study suggest that additional MRA to GDMT at discharge is one of the therapeutic options for elderly HF patients with reduced LVEF. This finding is not well documented in previous clinical trials. |
| first_indexed | 2024-12-22T15:43:43Z |
| format | Article |
| id | doaj.art-2b354ef76ba3480a97f49343d3934c35 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-22T15:43:43Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-2b354ef76ba3480a97f49343d3934c352022-12-21T18:21:05ZengWileyESC Heart Failure2055-58222020-10-01752711272410.1002/ehf2.12862Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patientsTakuro Abe0Kentaro Jujo1Motoko Kametani2Yuichiro Minami3Noritoshi Fukushima4Katsumi Saito5Nobuhisa Hagiwara6Department of Cardiology Tokyo Women's Medical University 8‐1 Kawadacho, Shinjuku‐ku Tokyo 162‐0054 JapanDepartment of Cardiology Tokyo Women's Medical University 8‐1 Kawadacho, Shinjuku‐ku Tokyo 162‐0054 JapanDepartment of Cardiology Tokyo Women's Medical University 8‐1 Kawadacho, Shinjuku‐ku Tokyo 162‐0054 JapanDepartment of Cardiology Tokyo Women's Medical University 8‐1 Kawadacho, Shinjuku‐ku Tokyo 162‐0054 JapanDepartment of Preventive Medicine and Public Health Tokyo Medical University Tokyo JapanDepartment of Cardiology Nishiarai Heart Center Hospital Tokyo JapanDepartment of Cardiology Tokyo Women's Medical University 8‐1 Kawadacho, Shinjuku‐ku Tokyo 162‐0054 JapanAbstract Aims Guideline‐directed medical therapy (GDMT) including beta‐blockers and renin–angiotensin system inhibitors is shown to reduce mortality risk in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, there is little evidence about the efficacy of additional administration of mineralocorticoid receptor antagonists (MRAs) with GDMT in patients ≥80 years presenting with HF. We aimed to investigate the prognostic impact of GDMT with MRA in relation to the age of patients with HF. Methods and results This observational study included patients admitted for HF with reduced LVEF who were discharged alive; among them, 224 patients were ≥80 years, and 661 patients were <80 years. Both populations were divided into three groups depending on whether they received GDMT with or without MRA or single/no GDMT drugs (GDMT+MRA+, GDMT+MRA−, or non‐GDMT, respectively). The primary endpoint was all‐cause mortality. In patients ≥80 years, all‐cause mortality was the lowest in the GDMT+MRA+ group (log‐rank trend, P = 0.034), and no significant differences were observed between the GDMT+MRA− and non‐GDMT groups. Multivariate Cox regression analysis revealed that GDMT+MRA+ was superior to GDMT+MRA−, even after adjusting for parameters at discharge (hazard ratio: 0.32, 95% confidence interval: 0.11–0.99). In patients <80 years, GDMT reduced all‐cause mortality; however, additional MRA was not associated with an improved outcome. Conclusions The results of this study suggest that additional MRA to GDMT at discharge is one of the therapeutic options for elderly HF patients with reduced LVEF. This finding is not well documented in previous clinical trials.https://doi.org/10.1002/ehf2.12862Heart failureGuideline‐directed medical therapyMineralocorticoid receptor antagonistOctogenarian |
| spellingShingle | Takuro Abe Kentaro Jujo Motoko Kametani Yuichiro Minami Noritoshi Fukushima Katsumi Saito Nobuhisa Hagiwara Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients ESC Heart Failure Heart failure Guideline‐directed medical therapy Mineralocorticoid receptor antagonist Octogenarian |
| title | Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| title_full | Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| title_fullStr | Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| title_full_unstemmed | Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| title_short | Prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| title_sort | prognostic impact of additional mineralocorticoid receptor antagonists in octogenarian heart failure patients |
| topic | Heart failure Guideline‐directed medical therapy Mineralocorticoid receptor antagonist Octogenarian |
| url | https://doi.org/10.1002/ehf2.12862 |
| work_keys_str_mv | AT takuroabe prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT kentarojujo prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT motokokametani prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT yuichirominami prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT noritoshifukushima prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT katsumisaito prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients AT nobuhisahagiwara prognosticimpactofadditionalmineralocorticoidreceptorantagonistsinoctogenarianheartfailurepatients |