Mineralocorticoid receptor antagonists (MRAs) should be considered for all patients with heart failure, say Scottish researchers who found benefits across the board.
The drugs, which include spironolactone, had already shown clear benefit for patients with heart failure and reduced ejection fraction but their use in other categories had been unclear.
Now, a meta-analysis of four trials with more than 13,800 patients presented at the European Society of Cardiology Congress 2024 has also shown positive results in patients with mildly reduced or preserved ejection fraction.
The results, which were also published in The Lancet, support use of the drugs in all heart failure patients without a contraindication, the researchers concluded.
Data was analysed from four placebo-controlled trials which either looked at spironolactone, eplerenone or finerenone.
It showed that MRAs reduced the risk of cardiovascular death or hospitalisation for heart failure by 23%.
The treatment did show greater efficacy in patients with heart failure and reduced ejection fraction with a 34% reduction in the death or hospitalisation.
But there was a 13% reduction in heart failure with mildly reduced or preserved ejection fraction.
The effects were consistent in all subgroups across the four trials and in all categories of heart failure, the researchers from the University of Glasgow said.
Significant reductions in hospitalisation for heart failure were observed in the trials of reduced ejection fraction (37%) and mildly reduced or preserved ejection fraction (18%).
And the same pattern was seen for total heart failure hospitalisations with or without cardiovascular death, they found.
The risk of hyperkalaemia was doubled with an MRA compared with placebo, but the incidence of serious hyperkalaemia, defined as a laboratory potassium >6.0 mmol/L, was low and the risk of hypokalaemia was halved.
Study leader Professor Pardeep Jhund, professor of cardiology and epidemiology at the University of Glasgow’s School of Cardiovascular and Metabolic Health, said that MRAs were widely available but several studies had shown they were underused.
‘This analysis confirms the benefits of MRAs in patients with heart failure, across the spectrum of ejection fractions,’ he said. ‘Our findings indicate that treatment with an MRA may be considered in all patients with heart failure without a contraindication.
‘In patients with mildly reduced or preserved ejection fraction, management should include finerenone in addition to a SGLT2 inhibitor,’ he said.
Meanwhile, a recent study found semaglutide could be beneficial in helping to treat patients with type 2 diabetes and obesity-related heart failure. In the trial of more than 600 patients with obesity-related heart failure with preserved ejection fraction and type 2 diabetes, semaglutide led to several benefits after one year.
A version of this article was originally published by our sister publication Pulse.
