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Heart failure & cardiomyopathiesMeta-analysis

Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis

LancetPublished

  • Individual patient level meta-analysis of randomised trials
  • prespecified
Read the original article ↗

Authors' conclusion

Steroidal MRAs reduce the risk of cardiovascular death or heart failure hospitalisation in patients with HFrEF and non-steroidal MRAs reduce this risk in patients with HFmrEF or HFpEF.

Study context

Population
Patients with HF across the range of EF (heart failure and reduced ejection fraction (HFrEF): RALES, EMPHASIS-HF; Heart failure and mildly reduced ejection fraction (HFmrEF) or heart failure and preserved ejection fraction (HFpEF): TOPCAT, FINEARTS-HF)
Participants
13,846 patients · 4 trials
Comparison
MRA vs placebo
Outcome
Composite of:
  • Time to first HF hospitalisation
  • CV death

Pooled result

As reported in the abstract

CV death or HF hospitalisation (time to first event)

Hazard ratio

0.77

95% CI 0.72–0.83

MRA vs Placebo
HR 0.77 (95% CI 0.72–0.83)
HFrEF trials: HR
0.66 [0.59-0.73] (95% CI)
HFmrEF or HFpEF trials: HR
0.87 [0.79-0.95] (95% CI)

Further pooled results

HF hospitalisation, by trial population

HFrEF trials: HR (95% CI), significant reduction
0.63 [0.55-0.72]
HFmrEF or HFpEF trials: HR (95% CI), significant reduction
0.82 [0.74-0.91]

Total HF hospitalisations with or without CV death

Same pattern as first HF hospitalisation

CV death, by trial population

HFrEF trials: HR (95% CI), reduced
0.72 [0.63-0.82]
HFmrEF or HFpEF trials: HR (95% CI), not reduced
0.92 [0.80-1.05]

All-cause death, by trial population

HFrEF trials: HR (95% CI), reduced
0.73 [0.65-0.83]
HFmrEF or HFpEF trials: HR (95% CI), not reduced
0.94 [0.85-1.03]

Safety

OutcomeOR (95% CI)
Hyperkalaemia2.27 (2.02–2.56)

Serious hyperkalaemia (serum potassium >6.0 mmol/L)

Hypokalaemia (potassium <3.5 mmol/L)

0.51 (CI 0.45–0.57)

Original publication

Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis. Lancet. Published 1 September 2024. doi:10.1016/s0140-6736(24)01733-1
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Summarised from the published abstract; every number is checked against it