Association Between Serum Albumin and Outcomes in Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial
Key result
Baseline serum albumin <4.0 g/dl was associated with a higher 4-year rate of all-cause death compared to levels ≥4.0 g/dl (63.7% vs 47.6%; adjusted HR 1.34; 95% CI 1.02-1.74; P=0.032).
Why the study?
The relationship between serum albumin levels and outcomes in patients with heart failure and secondary mitral regurgitation had not been described.
Does baseline serum albumin level predict outcomes and modify the treatment effect of TEER in patients with HF and severe SMR?
Population
559 patients with symptomatic HF and moderate-to-severe or severe SMR
Comparison
Albumin <4.0 g/dl vs ≥4.0 g/dl (and TEER plus GDMT vs GDMT alone)
Design
Post hoc analysis of a randomized trial
Follow-up
4-year
Authors
Discussion
Loading...
Member takes
Implication
Suggests low albumin identifies higher-risk patients but should not preclude TEER; leaves open whether.
Study Design
Type
RCT (n=559)
Randomization
randomized
Structured PICO
Does baseline serum albumin level predict outcomes and modify the treatment effect of TEER in patients with HF and severe SMR?
P
Population
559 patients with symptomatic heart failure and moderate-to-severe or severe secondary mitral regurgitation, followed for 4 years.
I
Intervention
Transcatheter edge-to-edge repair (TEER) plus guideline-directed medical therapy (GDMT), stratified by baseline serum albumin (<4.0 g/dl vs ≥4.0 g/dl)
C
Comparator
Guideline-directed medical therapy (GDMT) alone, stratified by baseline serum albumin
O
Outcome
4-year rates of all-cause deathhard clinical
Main Result
Hazard Ratio: 1.34 (95% CI 1.02–1.74)
Absolute Event Rate: 63.7% vs 47.6%
p-value: p=0.032
Low baseline serum albumin is an independent predictor of mortality in patients with HF and severe SMR, but does not attenuate the clinical benefits of TEER.
Cite This Study
Feng et al. (2023) conducted an RCT in Heart failure and secondary mitral regurgitation (n=559). Serum albumin <4.0 g/dl vs. Serum albumin ≥4.0 g/dl was evaluated on all-cause death (adjusted HR 1.34, 95% CI 1.02-1.74, p=0.032). Baseline serum albumin <4.0 g/dl was associated with a higher 4-year rate of all-cause death compared to levels ≥4.0 g/dl (63.7% vs 47.6%; adjusted HR 1.34; 95% CI 1.02-1.74; P=0.032).