Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure

Yaku, Hidenori; Morimoto, Takeshi; Inuzuka, Yasutaka; Tamaki, Yodo; Ozasa, Neiko; Yamamoto, Etsuhide; Yoshikawa, Yusuke; Kitai, Takeshi; Taniguchi, Ryoji; Iguchi, Moritake; Kato, Masashi; Takahashi, Mamoru; Jinnai, Toshikazu; Ikeda, Tomoyuki; Nagao, Keisuke; Kawai, Toshiyuki; Komasa, Akihiro; Nishikawa, Ryusuke; Kawase, Yoshiaki; Morinaga, Takashi; Toyofuku, Mamoru; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Shizuta, Satoshi; Ono, Koh; Sato, Yukihito; Kuwahara, Koichiro; Kimura, Takeshi

doi:10.1001/jamanetworkopen.2019.5892

Cited by 54 publications

(74 citation statements)

References 30 publications

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“…We collected data on patient demographics, medical history, underlying heart disease, pre-hospital activities, socioeconomic status, signs, symptoms, medications, laboratory tests at hospital presentation, electrocardiogram, echocardiography, and clinical events during the index hospitalization 9,17,18 .…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

“…We set the occurrence of new infection or infection that became obvious after hospitalization as one of the secondary outcomes. The causes of death were classified according to the VARC (Valve Academic Research Consortium) definitions 20 , and were adjudicated by a clinical event committee 9,15,17,18 .…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

“…Low (N = 1568, 63.5% Length of hospital stay 15 [11][12][13][14][15][16][17][18][19][20][21][22][23] 18 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] <0.0001 Table 1. Patient Characteristics of the Study Population.…”

Section: Conut Scorementioning

confidence: 99%

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Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure

Kato

Yaku

Morimoto

et al. 2020

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the high controlling nutritional status (conUt) score that represents poor nutritional status has been acknowledged to have prognostic implications in chronic heart failure. We aimed to investigate its role in acute decompensated heart failure (ADHf). Using the data from an multicenter registry that enrolled 4056 consecutive patients hospitalized for ADHF in Japan between 2014 and 2016, we analyzed 2466 patients in whom data on the components of the conUt score at hospital presentation were available. The decrease of lymphocyte count and total cholesterol was assigned with 0, 1, 2, and 3 points and the decrease of albumin was assigned with 0, 2, 4, and 6 points according to the severity. We defined low CONUT score as 0-4 (N = 1568) and high CONUT score as 5-9 (N = 898). The patients in the high CONUT score group were older and more likely to have a smaller body mass index than those in the low conUt score group. the high conUt score group was associated with higher rate of death and infection during the index hospitalization compared to the low CONUT score group (9.0% versus 4.4%, and 21.9% versus 12.7%, respectively). After adjusting for confounders, the excess risk of high relative to low CONUT score for mortality and infection was significant (OR: 1.61, 95%CI: 1.05-2.44, and OR: 1.66, 95%CI: 1.30-2.12, respectively). The effect was incremental according to the score. High CONUT score was associated with higher risk for in-hospital mortality and infection in an incremental manner in patients hospitalized for ADHf. Despite recent advances in chronic heart failure (HF) therapy, there remain unmet needs to reduce the high mortality rate and to assess the mortality risk in patients hospitalized for acute decompensated HF (ADHF) 1 .

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Section: Data Collection and Definitionsmentioning

confidence: 99%

Section: Data Collection and Definitionsmentioning

confidence: 99%

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Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure

Kato

Yaku

Morimoto

et al. 2020

Sci Rep

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“…The details of the design and patient enrollment have been described previously [ 8 , 21 , 22 ]. In brief, we consecutively enrolled the patients who had the acute HF symptoms defined by the modified Framingham criteria and who received treatment for heart failure involving intravenous drugs (e.g.…”

Section: Methodsmentioning

confidence: 99%

Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

et al. 2020

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Objective This observational study aimed to examine the prognostic association of angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) in different left ventricular ejection fraction (LVEF) categories. Methods In 3717 patients enrolled in the KCHF Registry, a multicentre registry including consecutive patients hospitalized for acute heart failure (HF), we assessed patient characteristics and association between ACE-I/ARB and clinical outcomes according to LVEF. In the three LVEF categories (reduced LVEF [HFrEF], mid-range LVEF [HFmrEF] and preserved LVEF [HFpEF]), we compared the patients with ACE-I/ARB as discharge medication and those without, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. Results The 1-year cumulative incidences of the primary outcome measure were 36.3% in HFrEF, 30.1% in HFmrEF and 33.8% in HFpEF (log-rank P = 0.07). The adjusted risks of the ACE-I/ARB group relative to the no ACE-I/ARB group for the primary outcome measure were significantly lower in HFrEF and HFmrEF (HR 0.66 [95%CI 0.54–0.79], P<0.001, and HR 0.61 [0.45–0.82], P = 0.001, respectively), but not in HFpEF (HR 0.95 [0.80–1.14], P = 0.61). There was a significant interaction between the LVEF category and the ACE-I/ARB use on the primary outcome measure (P interaction = 0.01). Conclusions ACE-I/ARB for patients who were hospitalized for acute HF was associated with significantly lower risk for a composite of all-cause death and HF hospitalization in HFrEF and HFmrEF, but not in HFpEF. ACE-I/ARB might be a potential treatment option in HFmrEF as in HFrEF.

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“…[15][16][17] In terms of HFpEF, the TOPCAT trial showed that spironolactone could reduce the rate of hospitalization for HF but not that of cardiovascular death or the composite outcome in stable HFpEF. 5 Although several other studies have provided supportive evidence of MRAs in HFpEF on post hoc analyses, [18][19][20] the drug's precise effect remains inconsistent in the literature. Additionally, there are no studies investigating the impact of MRAs on cardiovascular mortality in acute decompensated HFpEF patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of mineralocorticoid receptor antagonist in patients with heart failure with preserved ejection fraction

et al. 2020

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Aims This study aims to investigate the prognostic impact of mineralocorticoid receptor antagonists (MRAs) on cardiovascular events in patients hospitalized for acute decompensated heart failure with preserved ejection fraction (HFpEF; defined as left ventricular ejection fraction ≥45%). Methods and results A prospective multicentre cohort study was conducted in Nagano prefecture, Japan, between July 2014 and December 2018 that contained 518 consecutive HFpEF patients hospitalized for acute decompensated heart failure (HF). The primary outcome was a composite of cardiovascular death and HF readmission. We compared the incidence of cardiovascular events between patients who were prescribed with MRAs and those who were not in a propensity score matched cohort using a Cox proportional hazards regression model with a propensity score derived from 23 baseline variables. For sensitivity analysis, we conducted Cox proportional hazards regression models for the primary outcome adjusting for 16 clinically relevant variables in the crude cohort. The median age was 83 years, and 53% were female. The median left ventricular ejection fraction was 61%. During a median follow-up of 553 days, the primary outcome occurred in 192 (37%) patients. MRAs were used in 255 (49%) patients. After analysis, a matched cohort consisting of 370 patients was created. After propensity score matching, the baseline characteristics were well balanced between the two groups. The incidence of the primary outcome was significantly lower in MRA users than in non-users [32% (59/185) vs. 49% (90/185); hazard ratio (HR) 0.669, 95% confidence interval (CI) 0.482-0.929, P = 0.016]. The incidence of cardiovascular death was also significantly lower in the MRA users [11% (21/185) vs. 22% (41/185); HR, 0.563; 95% CI, 0.333-0.953; P = 0.032]. The risk of HF readmission tended to be lower in the MRA users [29% (54/185) vs. 41% (75/185); HR, 0.738; 95% CI, 0.520-1.048; P = 0.089]. MRA use was also associated with a lower risk of the primary outcome after Cox proportional hazards analysis adjusting for 16 clinically relevant variables in the crude cohort (HR, 0.710; 95% CI 0.507-0.995; P = 0.047). Conclusions Mineralocorticoid receptor antagonist use was significantly associated with a lower risk of the primary composite outcome of cardiovascular death and HF readmission in patients hospitalized for acute decompensated HFpEF. The incidence of cardiovascular mortality was also significantly lower in these patients.

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Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure

Cited by 54 publications

References 30 publications

Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure

Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure

Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

Prognostic impact of mineralocorticoid receptor antagonist in patients with heart failure with preserved ejection fraction

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