Key result
Aldosterone antagonists reduced the incidence of new-onset atrial fibrillation by 42% (RR 0.58) compared to placebo in adult patients with congestive heart failure.
Why the study?
Do aldosterone antagonists reduce the incidence of new-onset atrial fibrillation in adult patients with congestive heart failure?
Meta-Analysis (n=5,114)
Do aldosterone antagonists reduce the incidence of new-onset atrial fibrillation in adult patients with congestive heart failure?
Effect estimate: RR 0.58 (95% CI 0.40, 0.85)
Absolute Event Rate: 3.9% vs 6.8%
p-value: p=0.005
The addition of aldosterone antagonists to the treatment of congestive heart failure significantly reduces the risk of new-onset atrial fibrillation, heart failure hospitalization, and cardiovascular death.
Supports aldosterone antagonist use in HF for AF prevention; confirms and extends their role beyond mortality benefit.
BACKGROUND: Onset of atrial fibrillation (AF) is related to congestive heart failure (CHF) severity. The renin angiotensin-aldosterone system activates the mineralcorticoid receptor in patients with CHF, increasing the concentration of aldosterone and cortisol levels. Prolonged, these may cause deleterious effects leading to arrhythmia, worsening of CHF and mortality. Aldosterone antagonists may influence the atrial fibrosis and remodeling, which may prevent the onset of AF in patients with CHF. METHODS: Randomized, double-blind trials were searched from PUBMED, Medline, Embase and Cochrane on the effect of aldosterone antagonists (i.e., spironolactone, eplerenone, or canrenone) vs placebo on the prevention of AF, worsening CHF and deaths from cardiovascular causes. Selected studies were subjected to meta-analysis on the effects on incidence of new-onset AF, death from cardiovascular causes, hospitalization from CHF, and hypokalemia. RESULTS: Four randomized trials were selected, for a total of 5,114 patients were identified and extracted. Aldosterone antagonists reduced the incidence of new-onset AF by 42% (relative risk [RR] 0.58; 95% CI 0.40, 0.85; p=0.005) vs placebo. Mortality from cardiovascular causes was reduced by 21% (RR 0.79; 95% CI 0.65, 0.96; p=0.002). The risk of hospitalization from CHF was reduced by 37% (RR 0.63; 95% CI 0.53, 0.76; p=0.00001). CONCLUSION: The additional of aldosterone antagonists to the treatment of CHF significantly reduced the risk of new-onset AF, hospitalization from CHF, and deaths from cardiovascular causes.
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Cosare et al. (2013) conducted a meta-analysis in Congestive Heart Failure (n=5,114). Aldosterone antagonists (spironolactone, eplerenone, or canrenone) vs. Placebo was evaluated on Incidence of new-onset atrial fibrillation (RR 0.58, 95% CI 0.40, 0.85, p=0.005). Aldosterone antagonists reduced the incidence of new-onset atrial fibrillation by 42% (RR 0.58) compared to placebo in adult patients with congestive heart failure.
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