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Impact of spironolactone in heart failure with mid-range ejection fraction: a future therapy?
Session:
Painel 2 - Insuficiência Cardíaca 8
Speaker:
Maria Inês Fiúza Pires
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Inês Pires; Maria Luisa Gonçalves; João Miguel Santos; Hugo Da Silva Antunes; Joana Laranjeira Correia; José Costa Cabral; Inês Almeida
Abstract
<p>Background: Heart failure with mid-range ejection fraction (HFmrEF) is a recently defined category of heart failure (HF), but there is limited evidence regarding its optimal treatment. Spironolactone has shown beneficial effects in patients (P) with HF with reduced ejection fraction. This study aims to investigate the prognostic impact of spironolactone in P with HFmrEF.</p> <p>Methods: All P admitted for acute HFmrEF for 7 years in a Cardiology Department were enrolled in this study. Spironolactone use at discharge was assessed. P were followed up for 18 months. The primary outcome was a composite of all-cause mortality or hospitalization for HF. Statistical analysis used chi-square and Mann-Whitney U tests; Kaplan-Meier curves and log-rank tests; and an unadjusted Cox model.</p> <p>Results: 157 P were included (mean age 75.0±10.6 years, 61.8% male). At discharge, spironolactone was prescribed in 71 P (45.2%). Its use was associated with absence of chronic kidney disease (p=0.022), previous treatment with loop diuretics (p=0.028) or spironolactone (p=0.002), and decreased creatinine (p=0.004) levels at admission. In survival analysis, P treated with spironolactone had a significant reduction in the primary outcome in the follow up at 3 months (p=0.041) and 6 months (p=0.035), but not at 12 months or 18 months. Of the components of the primary outcome, only hospitalization for HF had a significantly lower incidence in spironolactone-treated P in the follow up at 3 months (p=0.010), 6 months (p=0.006), 12 months (p=0.037) and 18 months (p=0.030); the unadjusted hazard ratio was 0.542 (95% CI 0.309-0.952, p=0.033) for reduction in hospitalization during the 18 months. In subgroup analysis, the beneficial effect of spironolactone in hospitalization was consistent among P stratified based on gender and comorbidities. However, there was a significant interaction between the effect of spironolactone and the level of hemoglobin (Hb) at admission (p=0.031), with greater benefit in P with Hb>10g/dL.</p> <p>Conclusion: In this study, spironolactone use in HFmrEF was associated with a reduction in the primary outcome in the 6-month follow up, as well as a significant decrease in hospitalization for HF in the 18-month follow up. This result was consistent among different subgroups, but there was a greater benefit in P with Hb>10g/dL. Therefore, spironolactone may be considered in the future in the management of P with HFmrEF in order to reduce the negative impact of this disease.</p>
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