Heart failure & cardiomyopathiesCohort study
Discontinuation and Reinitiation of Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Reduced Ejection Fraction
- Registry-based cohort study
- Swedish Heart Failure Registry linked to Prescribed Drug Register
- Kaplan-Meier
- multivariable Cox proportional hazards models
Authors' conclusion
Among patients with HFrEF initiated on MRA, 71% remained on therapy at 1 year. Discontinuation occurred early and was more common in patients with advanced kidney disease, hyperkalaemia, lack of follow-up in specialty care, more severe heart failure, comorbidities, and markers of sociodemographic frailty. Among those who discontinued, almost half reinitiated treatment the year following discontinuation.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) newly started on mineralocorticoid receptor antagonists (MRA), Swedish Heart Failure Registry, 2006–2021
- Participants
- 11,474 MRA new users
- Outcome
- MRA discontinuation during the first year of treatment and reinitiation the year after discontinuation
- Follow-up
- 1 year
Main finding
As reported in the abstract
Remaining on MRA therapy
Remained on MRA therapy at 1 year
71%
Observational data: associations, not effects.
Further findings
Baseline predictors of discontinuation
- Estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m²: HR
- 1.75 (95% CI 1.34-2.27)
- Hyperkalaemia: HR
- 1.73 (95% CI 1.25-2.40)
- eGFR 30-60 ml/min/1.73 m²: HR
- 1.51 (95% CI 1.37-1.66)
- Age ≥80 years: HR
- 1.26 (95% CI 1.10-1.43)
- Enrolment as inpatient: HR
- 1.25 (95% CI 1.14-1.38)
- AF: HR
- 1.24 (95% CI 1.10-1.39)
- Living alone: HR
- 1.23 (95% CI 1.13-1.34)
- Ischaemic heart disease: HR
- 1.20 (95% CI 1.09-1.31)
- Anaemia: HR
- 1.17 (95% CI 1.07-1.29)
- DM: HR
- 1.15 (95% CI 1.04-1.27)
- NYHA class III-IV: HR
- 1.13 (95% CI 1.02-1.24)
- independently associated (multivariable Cox)
Reinitiation within a year of discontinuation
- Reinitiation within a year, mostly within 3 months after discontinuation
- 46%
Original publication
Discontinuation and Reinitiation of Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Reduced Ejection Fraction. Eur J Heart Fail. Published 26 November 2024. doi:10.1002/ejhf.3523
Summarised from the published abstract; every number is checked against it