ORC ID , Mohammed Al-Jarallah2 ORC ID , Rajesh Rajan2 ORC ID , Kadhim Sulaiman3, Raja Dashti4 ORC ID , Bassam Bulbanat5, Alawi A Alsheikh-Ali6, Prashanth Panduranga3, Khalid F AlHabib7, Jassim Al Suwaidi8, Wael Al-Mahmeed6, Hussam AlFaleh9, Abdelfatah Elasfar10, Ahmed Al-Motarreb11, Mustafa Ridha12, Nooshin Bazargani13, Nidal Asaad14, Haitham Amin15, Amar M Salam16">
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ORIGINAL ARTICLE
Year : 2021  |  Volume : 3  |  Issue : 1  |  Page : 14-19

The Impact of mineralocorticoid receptor antagonist use on all-cause mortality in acute heart failure patients


1 Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University; Gulf Health Research, Muscat, Oman
2 Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
3 Department of Cardiology, Royal Hospital, Muscat, Oman
4 Department of Cardiologist, Sabah Al-Ahmed Cardiac Center, Kuwait City, Kuwait
5 Department of Cardiology, Sabah Al Ahmed Cardiac Center, Kuwait City, Kuwait
6 Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
7 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
8 Department of Cardiology, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
9 Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
10 Department of Adult Cardiology, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Cardiology, Tanta University, Tanta, Egypt
11 Department of Internal Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen, Yemen<
12 Department of Cardiology, Adan Hospital, Kuwait City, Kuwait
13 Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
14 Department of Cardiology, Hamad General Hospital and Weill Cornell Medical College, New York City, New York, USA
15 Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
16 Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar

Correspondence Address:
Dr. Rajesh Rajan
Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City 13001
Kuwait
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_3_21

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Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure (AHF) patients in the Middle East is not well studied. The objective of this study was to examine the impact of MRA therapy on all-cause mortality in AHF patients in the Middle East stratified by left ventricular ejection fraction. Methods: Data were analyzed from 3792 consecutive patients admitted to 47 hospitals in 7 Middle Eastern countries. Results: The overall mean age was 59 ± 15 years and 62% (n = 2353) were male. At discharge, MRA therapy was prescribed in 34% (n = 1301) of the patients. A total of 54% (n = 2048) of the patients had AHF with reduced ejection fraction (EF) (HFrEF) (<40%), 23% (n = 880) had HF with mid-range EF (HFmrEF) (40%–49%), and 23% (n = 864) had HF with preserved EF (HFpEF) (≥50%). MRA therapy was associated with lower cumulative all-cause 3-month mortality in those with HFrEF (adjusted odds ratio [aOR], 0.55; 95% [confidence interval (CI): 0.37–0.80: P = 0.002), those with HFmrEF (aOR, 0.43; 95% CI: 0.19–0.99: P = 0.047), and in those with HFpEF (aOR, 0.45; 95% CI: 0.22–0.92: P = 0.029) when compared to those that were not on MRA therapy. MRA therapy was also associated with lower cumulative all-cause 12-month mortality in those with HFrEF (aOR, 0.65; 95% CI: 0.49–0.86: P = 0.002) and in those with HFmrEF (0.52; 95% CI: 0.29–0.91: P = 0.021). Conclusion: MRA therapy was associated with lower all-cause mortality at 3 months and at 12 months in AHF patients with reduced and mid-range EF in the Middle East.


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