Heart failure & cardiomyopathiesCohort study
Initiation of eplerenone vs. spironolactone and all-cause mortality in heart failure with reduced ejection fraction (HFrEF): linked database study
- non-interventional database study
- nationwide Danish health registries
- active-comparator, new-user design
- inverse-probability-of-treatment weighting based on propensity scores
Authors' conclusion
In this large nationwide study, initiation of eplerenone was associated with lower risks of all-cause and cardiovascular mortality compared with spironolactone, with findings suggesting a contribution of better treatment persistence.
Study context
- Population
- Patients aged ≥45 years with HFrEF (ejection fraction ≤40%) initiating eplerenone or spironolactone, Danish health registries, 1 January 2020 to 30 June 2025eplerenone 4,550 · spironolactone 6,651
- Participants
- 4,550 vs 6,651
- Exposure
- Initiation of eplerenone vs. spironolactone
- eplerenonen = 4,550
- spironolactonen = 6,651
- Outcome
- All-cause mortality
- Follow-up
- Median was 2.3 years
Main finding
As reported in the abstract
eplerenone
5.0 per 100 person-years
571 of 4550
spironolactone
7.0 per 100 person-years
1168 of 6651
- lower risk of death with eplerenone
- wHR 0.83 (95% CI 0.75–0.93)
- All-cause mortality
- absolute rate difference −1.10 per 100 person-years (95% CI −0.50 to −1.70)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | wHR (95% CI) |
|---|---|
| Cardiovascular death or heart failure hospitalization · secondary outcome | 0.89 (0.81–0.98) |
| Cardiovascular death · secondary outcome | 0.79 (0.67–0.92) |
| Heart failure hospitalization · secondary outcome | 0.97 (0.87–1.09) |
Per-protocol analyses
- Effect estimates were attenuated in per-protocol analyses
Original publication
Initiation of eplerenone vs. spironolactone and all-cause mortality in HFrEF: linked database study. Eur Heart J Cardiovasc Pharmacother. Published 28 April 2026. doi:10.1093/ehjcvp/pvag030
Summarised from the published abstract; every number is checked against it