Eplerenone reduced the risk of a composite of all-cause mortality, HF re-hospitalization, worsening HF, and diuretic intensification compared to placebo (HR 0.53; 95% CI 0.29-0.97).
RCT (n=296)
randomized
Does eplerenone reduce adverse clinical outcomes in patients hospitalized for acute heart failure regardless of albuminuria severity?
In patients hospitalized for acute heart failure, eplerenone reduces the composite risk of mortality and worsening heart failure regardless of baseline albuminuria severity, which itself serves as an independent prognostic marker.
Hazard Ratio: 0.53 (95% CI 0.29–0.97)
Abstract Background Patients hospitalized for acute heart failure (AHF) have high degrees of congestion, which may be associated with albuminuria. Mineralocorticoid receptor antagonists (MRAs) have natriuretic effects, possibly diminishing the degree of albuminuria. However, early changes in albuminuria, their prognostic value and interaction with MRA therapy remain unclear. Methods The EARLIER trial included patients with AHF who were randomized to receive eplerenone or placebo over 6 months. Urine albumin-to-creatinine ratio (UACR) at admission and week 1 were measured, and Cox proportional hazards models were used for analyses. Results Among 296 patients (mean age, 67±13years; 75% male), median B-type natriuretic peptide was 332 (145-529) pg/ml, and mean left ventricular ejection fraction was 30±8%. Patients with an UACR of ≥30 mg/g at admission had more severe signs and symptom of congestion compared to those without (all-P0.01). From admission to week 1, UACR levels significantly decreased (P0.01), without significant differences between treatment groups (P0.10). UACR levels at both admission (adjusted-HR 95% CI=1.23 1.03-1.47) and week 1 (adjusted-HR 95% CI=1.23 1.01-1.50) were associated with the risk of cardiovascular death and hospitalization over 6 months. Additionally, eplerenone vs. placebo reduced the risk of a composite of all-cause mortality, HF re-hospitalization, investigator-reported worsening HF, and out-of-hospital diuretic intensification (HR 95% CI= 0.53 0.29-0.97), regardless of the albuminuria severity (P-for-interaction0.10). Conclusion In patients with AHF, the degree of albuminuria at both admission and week 1 was associated with post-discharge prognosis. Although eplerenone did not reduce albuminuria levels, the benefit from eplerenone was consistent regardless of the albuminuria severity.
Tezuka et al. (Sat,) conducted a rct in acute heart failure (n=296). eplerenone vs. placebo was evaluated on composite of all-cause mortality, HF re-hospitalization, investigator-reported worsening HF, and out-of-hospital diuretic intensification (HR 0.53, 95% CI 0.29-0.97). Eplerenone reduced the risk of a composite of all-cause mortality, HF re-hospitalization, worsening HF, and diuretic intensification compared to placebo (HR 0.53; 95% CI 0.29-0.97).