Heart failure & cardiomyopathiesCohort study
Mineralocorticoid receptor antagonists in patients with transthyretin amyloid cardiomyopathy receiving disease-modifying therapy
- retrospective cohort study
- 1:1 propensity-score matching
- TriNetX US database
Authors' conclusion
In a contemporary cohort of patients with ATTR-CM treated with disease-modifying therapy, MRA use was associated with limited incremental clinical benefits.
Study context
- Population
- Adult patients with ATTR-CM who initiated disease-modifying therapy (tafamidis or vutrisiran) within 1 year of incident heart failure (HF) diagnosis between 1 September 2019 and 10 December 2025patients with ATTR-CM, 505 MRA users matched to 505 non-users · tafamidis 4,386 · vutrisiran 377
- Participants
- 4,598 patients
- Exposure
- MRA users vs non-users
- MRA usersn = 505
- non-usersn = 505reference
Main finding
As reported in the abstract
Composite of:
- All-cause mortality
- HF hospitalisation (HFH)
Hazard ratio
1.04
95% CI 0.82–1.32
P = 0.73
MRA users vs non-users
HR 1.04 (95% CI 0.82–1.32); P = 0.73
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality · secondary endpoint | 1.00 (0.70–1.46) | P = 0.96 | |
| HFH · secondary endpoint | 1.09 (0.84–1.43) | P = 0.48 | |
| Ventricular arrhythmia (VA) · secondary endpoint | 1.07 (0.77–1.48) | P = 0.67 | |
| 0.512Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Hyperkalaemia · not significantly higher in MRA users | 1.13 (0.89–1.44) | P = 0.29 | |
| 0.512Hazard ratio (log scale) |
Original publication
Mineralocorticoid receptor antagonists in patients with transthyretin amyloid cardiomyopathy receiving disease-modifying therapy. Heart. Published 7 August 2026. doi:10.1136/heartjnl-2026-328038
Summarised from the published abstract; every number is checked against it