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Real world comparison of spironolactone and eplerenone in patients with heart failure

  • Patricia Pardo-Martínez
    Affiliations
    Servicio de Cardiología, Hospital Universitario Arquitecto Marcide, Ferrol (A Coruña), Spain
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  • Eduardo Barge-Caballero
    Correspondence
    Corresponding author: Unidad de Insuficiencia Cardiaca y Trasplante. Servicio de Cardiología. Complejo Hospitalario Universitario de A Coruña (CHUAC). As Xubias, 84, CP 15006, A Coruña, Spain.
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Alberto Bouzas-Mosquera
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Gonzalo Barge-Caballero
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • David Couto-Mallón
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • María J. Paniagua-Martín
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Marta Sagastagoitia-Fornie
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain
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  • Óscar Prada-Delgado
    Affiliations
    Servicio de Cardiología, Hospital Universitario Arquitecto Marcide, Ferrol (A Coruña), Spain
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  • Javier Muñiz
    Affiliations
    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • Luis Almenar-Bonet
    Affiliations
    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain

    Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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  • José M. Vázquez-Rodríguez
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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  • María G. Crespo-Leiro
    Affiliations
    Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain

    Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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Published:January 06, 2022DOI:https://doi.org/10.1016/j.ejim.2021.12.027

      Highlights

      • Treatment with a mineralocorticoid receptor antagonist (MRA) –spironolactone or eplerenone– is indicated to reduce the risk of hospital admission and death in patients with symptomatic heart failure (HF) and reduced left ventricular ejection fraction.
      • Despite there are a few differences between spironolactone and eplerenone with regard to their biological properties and safety profile, no randomized clinical trial has compared them directly in patients with HF.
      • The present single-center, propensity-score matched study compared the long-term outcomes of 293 real-world patients with HF and reduced ejection fraction treated with eplerenone and 293 propensity-score matched controls treated with eplerenone.
      • No significant differences between patients treated with spironolactone or eplerenone were observed with regard to the primary combined end-point cardiovascular death or HF hospitalization.
      • Patients treated with eplerenone presented significantly lower risk of cardiovascular mortality and all-cause mortality than patients treated with spironolactone.

      Abstract

      Aims

      In the absence of previous direct comparative studies, we aimed to evaluate the effectiveness of spironolactone and eplerenone in patients with heart failure and reduced ejection fraction (HFrEF) in a real-world clinical setting.

      Methods

      Using Fine-Gray´s competing risk regression, we compared the clinical outcomes of 293 patients with chronic HF and left ventricular ejection fraction <40% treated with eplerenone and 293 propensity-score matched individuals treated with spironolactone. Study subjects were selected from a prospective cohort of 1404 ambulatory patients with HFrEF seen since 2010 to 2019 in a single specialized HF clinic, among which 992 received a mineralocorticoid receptor antagonist at baseline. Median follow-up was 3.95 years.

      Results

      No statistically significant differences between patients treated with eplerenone versus spironolactone were observed with regard to the risk of the primary composite end-point cardiovascular death or HF hospitalization (HR 0.95; 95% CI 0.73–1.23; p= 0.677). However, eplerenone use was associated to lower cardiovascular mortality (HR 0.55; 95% CI 0.35–0.85; p= 0.008) and lower all-cause mortality (HR 0.67; 95% CI 0.47–0.95; p= 0.027). The incidence of drug suspension due to side effects (HR 0.58, 95% CI 0.40–0.85; p= 0.005) and drug suspension due to any reason (HR 0.70, 95% CI 0.51–0.97; p= 0.033) were lower among patients treated with eplerenone.

      Conclusions

      In this observational, real-world, propensity-score matched study of patients with HFrEF, eplerenone was associated to lower cardiovascular mortality and lower all-cause mortality than spironolactone.

      Keywords

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