Key result
Spironolactone therapy was associated with reduced heart failure hospitalization (HR 0.71, 95% CI 0.63-0.80) and all-cause mortality (HR 0.69, 95% CI 0.59-0.82) vs standard care in HFmrEF/HFpEF.
Why the study?
Real-world evidence for mineralocorticoid receptor antagonists in HFmrEF and HFpEF remains scarce, particularly in Asian populations who are underrepresented in pivotal trials.
Does spironolactone reduce heart failure hospitalization and all-cause mortality compared to standard care in Southeast Asian patients with HFmrEF and HFpEF?
Cohort (n=9,479)
Does spironolactone reduce heart failure hospitalization and all-cause mortality compared to standard care in Southeast Asian patients with HFmrEF and HFpEF?
In a large real-world Southeast Asian cohort, spironolactone was associated with significant reductions in both heart failure hospitalizations and all-cause mortality among patients with HFmrEF and HFpEF.
Supports MRA use in real-world HFmrEF/HFpEF; extends FINEARTS-HF to Southeast Asian cohorts but remains hypothesis-generating.
Background While recent trials such as FINEARTS-HF have reignited interest in mineralocorticoid receptor antagonists (MRAs) for heart failure with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF), real-world evidence remains scarce, particularly in Asian populations, who are underrepresented in pivotal trials. We aimed to evaluate the comparative effectiveness of spironolactone versus standard care on long-term outcomes in a large real-world cohort of Southeast Asian patients with HFmrEF and HFpEF. Methods We conducted a retrospective cohort study using the RAMA-HF database (2010–2024), including 9,479 patients with HFmrEF (LVEF 40-49%) or HFpEF (LVEF ≥50%). Patients were categorized into an MRA group (spironolactone, n=3,486) and a control group (n=5,993). To address confounding by indication, we employed inverse probability weighting (IPW) with propensity scores derived from 12 key covariates, achieving excellent balance (SMD < 0.2). Primary outcomes were heart failure hospitalization (HFH) and all-cause mortality. Results Over a median follow-up of approximately 3.7 years, MRA therapy was associated with a significant 29% reduction in the risk of HFH (HR 0.71, 95% CI 0.63-0.80, p<0.001). Furthermore, MRA use demonstrated a robust 31% reduction in all-cause mortality (HR 0.69, 95% CI 0.59-0.82, p<0.001) compared to standard care. Subgroup analyses revealed consistent benefits across phenotypes: HFH risk was significantly reduced in both HFpEF (HR 0.72) and HFmrEF (HR 0.64). Mortality benefits were particularly pronounced in the HFpEF population (HR 0.64, p<0.001). Conclusion In this large, real-world study, spironolactone therapy was associated with substantial reductions in hospitalizations and mortality among patients with HFmrEF and HFpEF. These findings support the clinical effectiveness of MRAs in a broader, unselected Asian population and support their expanded use as a valuable therapeutic option across the ejection fraction spectrum, potentially improving outcomes in these historically difficult-to-treat phenotypes.survival curves for HFHsurvival curves for all-cause mortality
No takes yet. Share an insight, caveat, or question.
Amornritvanich et al. (2026) conducted a cohort in Heart failure with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF) (n=9,479). Spironolactone (mineralocorticoid receptor antagonist) vs. Standard care (control group) was evaluated on Heart failure hospitalization (HFH) and all-cause mortality (HR 0.71, 95% CI 0.63-0.80, p=<0.001). Spironolactone therapy was associated with reduced heart failure hospitalization (HR 0.71, 95% CI 0.63-0.80) and all-cause mortality (HR 0.69, 95% CI 0.59-0.82) vs standard care in HFmrEF/HFpEF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: