Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction
Abstract Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). M...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-02-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12571 |
| _version_ | 1819016933832392704 |
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| author | Nobuyuki Enzan Shouji Matsushima Tomomi Ide Hidetaka Kaku Taiki Higo Miyuki Tsuchihashi‐Makaya Hiroyuki Tsutsui |
| author_facet | Nobuyuki Enzan Shouji Matsushima Tomomi Ide Hidetaka Kaku Taiki Higo Miyuki Tsuchihashi‐Makaya Hiroyuki Tsutsui |
| author_sort | Nobuyuki Enzan |
| collection | DOAJ |
| description | Abstract Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). Methods and results We analysed HFmrEF (left ventricular EF 40–49%) patients enrolled in the Japanese Cardiac Registry of Heart Failure in Cardiology, which prospectively studied the clinical characteristics, treatments, and long‐term outcomes of patients hospitalized due to HF. Patients were divided into two groups according to the use of spironolactone at discharge. The primary outcome was a composite of all‐cause death or HF rehospitalization. A total of 457 patients had HFmrEF. The mean age was 69.3 years and 286 (62.6%) were male. Among them, spironolactone was prescribed at discharge in 158 patients (34.6%). Chronic kidney disease (7.6% vs. 16.8%, P = 0.007) was less prevalent and loop diuretics (89.2% vs. 70.2%, P < 0.001) were more often prescribed in patients with spironolactone. During a mean follow‐up of 2.2 years, patients with spironolactone had a lower incidence rate of the primary outcome than those without it (171.5 vs. 278.8 primary outcome per 1000 patient‐years, incidence rate ratio 0.61, 95% confidence interval 0.44–0.86; P = 0.004). After multivariable adjustment, spironolactone use at discharge was associated with a significant reduction in the composite of all‐cause death or HF rehospitalization (adjusted hazard ratio 0.63, 95% confidence interval 0.44–0.90, P = 0.010). Conclusions Among patients with HF hospitalized for HFmrEF, spironolactone use at discharge was associated with better long‐term outcomes. |
| first_indexed | 2024-12-21T02:55:30Z |
| format | Article |
| id | doaj.art-a393c1a5ab4144b09ab24977a5ea2f4e |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-21T02:55:30Z |
| publishDate | 2020-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-a393c1a5ab4144b09ab24977a5ea2f4e2022-12-21T19:18:21ZengWileyESC Heart Failure2055-58222020-02-017133634410.1002/ehf2.12571Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fractionNobuyuki Enzan0Shouji Matsushima1Tomomi Ide2Hidetaka Kaku3Taiki Higo4Miyuki Tsuchihashi‐Makaya5Hiroyuki Tsutsui6Department of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanDepartment of Cardiovascular Medicine Kyushu University Hospital Maidashi 3‐1‐1, Higashi‐ku Fukuoka 812‐8582 JapanDepartment of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanKitasato University School of Nursing Sagamihara JapanDepartment of Cardiovascular Medicine, Faculty of Medical Sciences Kyushu University Fukuoka JapanAbstract Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). Methods and results We analysed HFmrEF (left ventricular EF 40–49%) patients enrolled in the Japanese Cardiac Registry of Heart Failure in Cardiology, which prospectively studied the clinical characteristics, treatments, and long‐term outcomes of patients hospitalized due to HF. Patients were divided into two groups according to the use of spironolactone at discharge. The primary outcome was a composite of all‐cause death or HF rehospitalization. A total of 457 patients had HFmrEF. The mean age was 69.3 years and 286 (62.6%) were male. Among them, spironolactone was prescribed at discharge in 158 patients (34.6%). Chronic kidney disease (7.6% vs. 16.8%, P = 0.007) was less prevalent and loop diuretics (89.2% vs. 70.2%, P < 0.001) were more often prescribed in patients with spironolactone. During a mean follow‐up of 2.2 years, patients with spironolactone had a lower incidence rate of the primary outcome than those without it (171.5 vs. 278.8 primary outcome per 1000 patient‐years, incidence rate ratio 0.61, 95% confidence interval 0.44–0.86; P = 0.004). After multivariable adjustment, spironolactone use at discharge was associated with a significant reduction in the composite of all‐cause death or HF rehospitalization (adjusted hazard ratio 0.63, 95% confidence interval 0.44–0.90, P = 0.010). Conclusions Among patients with HF hospitalized for HFmrEF, spironolactone use at discharge was associated with better long‐term outcomes.https://doi.org/10.1002/ehf2.12571SpironolactoneHeart failure with mid‐range ejection fractionOutcomesRehospitalization |
| spellingShingle | Nobuyuki Enzan Shouji Matsushima Tomomi Ide Hidetaka Kaku Taiki Higo Miyuki Tsuchihashi‐Makaya Hiroyuki Tsutsui Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction ESC Heart Failure Spironolactone Heart failure with mid‐range ejection fraction Outcomes Rehospitalization |
| title | Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction |
| title_full | Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction |
| title_fullStr | Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction |
| title_full_unstemmed | Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction |
| title_short | Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction |
| title_sort | spironolactone use is associated with improved outcomes in heart failure with mid range ejection fraction |
| topic | Spironolactone Heart failure with mid‐range ejection fraction Outcomes Rehospitalization |
| url | https://doi.org/10.1002/ehf2.12571 |
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