Key result
Treatment with mineralocorticoid receptor antagonists was not associated with improved all-cause mortality at 3 years (22% vs 24%; HR 1.008; 95% CI 0.690-1.472; p=0.968).
Why the study?
The study sought to assess the effect of mineralocorticoid receptor antagonist treatment on the long-term prognosis of patients with systolic HF surviving index episodes of ventricular tachyarrhythmias.
Do mineralocorticoid receptor antagonists (MRAs) reduce all-cause mortality in patients with systolic heart failure (LVEF <45%) surviving index episodes of ventricular tachyarrhythmias?
Cohort (n=748)
Do mineralocorticoid receptor antagonists (MRAs) reduce all-cause mortality in patients with systolic heart failure (LVEF <45%) surviving index episodes of ventricular tachyarrhythmias?
In a retrospective registry of patients with systolic heart failure and ventricular tachyarrhythmias, MRA treatment was not associated with improved 3-year all-cause mortality or reduced recurrent arrhythmias.
MRA use showed no mortality benefit; should not change practice and leaves open efficacy in systolic HF with ventricular tachyarrhythmias.
INTRODUCTION: The study sought to assess the effect of treatment with mineralocorticoid receptor antagonists (MRAs) on long-term prognosis of patients with systolic heart failure (HF) surviving index episodes of ventricular tachyarrhythmias. METHODS: A large retrospective registry was used including consecutive HF patients with left ventricular ejection fraction <45% and index episodes of ventricular tachyarrhythmias from 2002 to 2015. The primary endpoint was all-cause mortality at 3 years and secondary endpoints were rehospitalization, as well as the composite endpoint consisting of recurrent ventricular tachyarrhythmias, sudden cardiac death and appropriate implantabe cardioverter defibrillator (ICD) therapies at 3 years. RESULTS: 748 patients were included, 20% treated with MRA and 80% without. At 3 years, treatment with MRA was not associated with improved all-cause mortality (22% vs. 24%, log-rank p = 0.968; hazard ratio (HR) = 1.008; 95% CI 0.690-1.472; p = 0.968). Accordingly, risk of the composite endpoint (28% vs. 27%; HR = 1.131; 95% CI 0.806-1.589; p = 0.476) and first cardiac rehospitalization (24% vs. 22%; HR = 1.139; 95% CI 0.788-1.648; p = 0.489) were not affected by treatment with MRA. CONCLUSION: In patients with ventricular tachyarrhythmias, treatment with MRA was not associated with improved all-cause mortality at 3 years. The therapeutic effect of MRA treatment in patients with ventricular tachyarrhythmias needs to be reinvestigated within further randomized controlled trials.
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Schupp et al. (2021) conducted a cohort in Systolic heart failure with ventricular tachyarrhythmias (n=748). Mineralocorticoid receptor antagonists (MRAs) vs. No MRA treatment was evaluated on All-cause mortality at 3 years (HR 1.008, 95% CI 0.690-1.472, p=0.968). Treatment with mineralocorticoid receptor antagonists was not associated with improved all-cause mortality at 3 years (22% vs 24%; HR 1.008; 95% CI 0.690-1.472; p=0.968).
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