The Impact of Mineralocorticoid Receptor Antagonist Use on All-cause Mortality in Acute Heart Failure Patients

Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure (AHF) patients in the Middle East is not well studied. The objective of this study was to examine the impact of MRA therapy on all-cause mortality in AHF patients in the Middle East stratified by left ventricular ejection fraction. Methods: Data were analyzed from 3792 consecutive patients admitted to 47 hospitals in 7 Middle Eastern countries. Results: The overall mean age was 59 ± 15 years and 62% ( n = 2353) were male. At discharge, MRA therapy was prescribed in 34% ( n = 1301) of the patients. A total of 54% ( n = 2048) of the patients had AHF with reduced ejection fraction (EF) (HFrEF) (<40%), 23% ( n = 880) had HF with mid-range EF (HFmrEF) (40%–49%), and 23% ( n = 864) had HF with preserved EF (HFpEF) (≥50%). MRA therapy was associated with lower cumulative all-cause 3-month mortality in those with HFrEF (adjusted odds ratio [aOR], 0.55; 95% [confidence interval (CI): 0.37–0.80: P = 0.002), those with HFmrEF (aOR, 0.43; 95% CI: 0.19–0.99: P = 0.047), and in those with HFpEF (aOR, 0.45; 95% CI: 0.22–0.92: P = 0.029) when compared to those that were not on MRA therapy. MRA therapy was also associated with lower cumulative all-cause 12-month mortality in those with HFrEF (aOR, 0.65; 95% CI: 0.49–0.86: P = 0.002) and in those with HFmrEF (0.52; 95% CI: 0.29–0.91: P = 0.021). Conclusion: MRA therapy was associated with lower all-cause mortality at 3 months and at 12 months in AHF patients with reduced and mid-range EF in the Middle East.