Heart failure & cardiomyopathiesMeta-analysis
Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials
- Systematic review and meta-analysis of randomised trials
- random-effects models
- interaction analyses
Authors' conclusion
Mineralocorticoid receptor antagonists are similarly effective in preventing cardiovascular events in patients with and without HF and most likely retain their efficacy regardless of AF status. Mineralocorticoid receptor antagonists may also be moderately effective in preventing incident or recurrent AF events.
Study context
- Population
- Patients with or at risk for CVD
- Participants
- 20,741 patients · 7 trials
- Comparison
- Mineralocorticoid receptor antagonists (MRAs) vs placebo or usual care
- Outcome
- CV death or HF hospitalization, by HF and AF status; AF events
Pooled result
As reported in the abstract
CV death or HF hospitalization, by HF status (subgroups)
MRAs vs PlaceboRelative risk (95% CI)
with HF
0.81(0.67–0.98)
without HF
0.84(0.75–0.93)
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| CV death or HF hospitalization in HF, by AF status (subgroups) — MRAs vs Placebo or usual care · with AF | HR 0.95 (95% CI 0.54–1.66) | |
| CV death or HF hospitalization in HF, by AF status (subgroups) — MRAs vs Placebo or usual care · without AF | HR 0.82 (95% CI 0.63–1.07) | |
| AF events · 20 trials, 21 791 participants; with and without prior AF | RR 0.76 (95% CI 0.67–0.87) | |
| 0.512Ratio (log scale) |
- CV death or heart failure (HF) hospitalization in HF, by atrial fibrillation (AF) status (subgroups): interaction P = .65
Original publication
Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials. Eur Heart J. Published 9 January 2024. doi:10.1093/eurheartj/ehad811
Summarised from the published abstract; every number is checked against it