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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Article info
Publication history
Published online: January 06, 2022
Accepted:
December 28,
2021
Received in revised form:
December 19,
2021
Received:
November 8,
2021
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
