Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Noemi Bruno, Gianfranco Sinagra, Stefania Paolillo, Alice Bonomi, Ugo Corrà, Massimo Piepoli, Fabrizio Veglia, Elisabetta Salvioni, Rocco Lagioia, Marco Metra, Giuseppe Limongelli, Gaia Cattadori, Angela B. Scardovi, Valentina Carubelli, Domenico Scrutino, Roberto Badagliacca, Marco Guazzi, Rosa Raimondo, Piero Gentile, Damiano MagrìMichele Correale, Gianfranco Parati, Federica Re, Mariantonietta Cicoira, Maria Frigerio, Maurizio Bussotti, Carlo Vignati, Fabrizio Oliva, Alessandro Mezzani, Giuseppe Vergaro, Andrea Di Lenarda, Claudio Passino, Susanna Sciomer, Giuseppe Pacileo, Roberto Ricci, Mauro Contini, Anna Apostolo, Pietro Palermo, Massimo Mapelli, Cosimo Carriere, Francesco Clemenza, Simone Binno, Romualdo Belardinelli, Carlo Lombardi, Pasquale Perrone Filardi, Michele Emdin, Piergiuseppe Agostoni

Research output: Contribution to journalArticlepeer-review


Aims: Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients. Methods and results: We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan–Meier, compared by log-rank test and propensity score matching. At 10 years' follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group (P < 0.001). MRA-treated patients had more severe heart failure (higher New York Heart Association class and lower left ventricular ejection fraction, kidney function, and peak VO2). At a propensity-score-matching analysis performed on 1587 patients, MRA-treated and MRA-untreated patients showed similar study endpoint values. Conclusions: In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real-life setting. A meticulous patient follow-up, as performed in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials.

Original languageEnglish
Pages (from-to)267-274
Number of pages8
JournalESC heart failure
Issue number3
Publication statusPublished - Jan 1 2018


  • Heart failure
  • Hyperkalaemia
  • Mineralocorticoid receptor antagonists
  • Worsening renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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