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

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

Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

52noAIMS: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. METHODS AND RESULTS: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P 2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns). CONCLUSION: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.reservedmixedPaolillo, Stefania; Mapelli, Massimo; Bonomi, Alice; Corrà, Ugo; Piepoli, Massimo; Veglia, Fabrizio; Salvioni, Elisabetta; Gentile, Piero; Lagioia, Rocco; Metra, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Carubelli, Valentina; Scrutino, Domenico; Badagliacca, Roberto; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Correale, Michele; Parati, Gianfranco; Caravita, Sergio; Spadafora, Emanuele; Re, Federica; Cicoira, Mariantonietta; Frigerio, Maria; Bussotti, Maurizio; Minà, Chiara; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi; Di Lenarda, Andrea; Passino, Claudio; Sciomer, Susanna; Iorio, Annamaria; Zambon, Elena; Guazzi, Marco; Pacileo, Giuseppe; Ricci, Roberto; Contini, Mauro; Apostolo, Anna; Palermo, Pietro; Clemenza, Francesco; Marchese, Giovanni; Binno, Simone; Lombardi, Carlo; Passantino, Andrea; Perrone Filardi, Pasquale; Agostoni, PiergiuseppePaolillo, Stefania; Mapelli, Massimo; Bonomi, Alice; Corrà, Ugo; Piepoli, Massimo; Veglia, Fabrizio; Salvioni, Elisabetta; Gentile, Piero; Lagioia, Rocco; Metra, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela B.; Carubelli, Valentina; Scrutino, Domenico; Badagliacca, Roberto; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Correale, Michele; Parati, Gianfranco; Caravita, Sergio; Spadafora, Emanuele; Re, Federica; Cicoira, Mariantonietta; Frigerio, Maria; Bussotti, Maurizio; Minà, Chiara; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi; Di Lenarda, Andrea; Passino, Claudio; Sciomer, Susanna; Iorio, Annamaria; Zambon, Elena; Guazzi, Marco; Pacileo, Giuseppe; Ricci, Roberto; Contini, Mauro; Apostolo, Anna; Palermo, Pietro; Clemenza, Francesco; Marchese, Giovanni; Binno, Simone; Lombardi, Carlo; Passantino, Andrea; Perrone Filardi, Pasquale; Agostoni, Piergiusepp