Temporal trends in initiation of mineralocorticoid receptor antagonists and risk of subsequent withdrawal in patients with heart failure: a nationwide study in Denmark from 2003–2017

Deewa Zahir*, Anders Bonde, Christian Madelaire, Morten Malmborg, Jawad H. Butt, Emil Fosbøl, Gunnar Gislason, Christian Torp-Pedersen, Charlotte Andersson, Patrick Rossignol, John J.V. McMurray, Lars Køber, Morten Schou

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

Aims: Despite landmark heart failure (HF) with reduced ejection fraction (HFrEF) trials showing effect of mineralocorticoid receptor antagonists (MRA) on the risk of death and HF hospitalization, it has been suggested that MRAs are underutilized or frequently withdrawn. This study sought to identify temporal trends in the initiation of MRAs and the subsequent risk of withdrawal and adherence of MRAs in HF patients treated with a renin–angiotensin system inhibitor and a beta-blocker in Denmark from 2003–2017. Methods and results: From nationwide registries, we identified patients receiving a diagnosis of HF. Use of MRA was identified by at least one prescription within 6 months after the diagnosis. The absolute risk of withdrawal with treatment was assessed with cumulative incidence, accounting for the competing risk of death. To estimate adherence, we calculated the proportion of days covered. We included 51 512 patients with incident HF. During the study period, 20 779 (40.3%) patients initiated MRA therapy. The incidence of withdrawal of MRA was 49.2% throughout the study period; 48.0% of the HF patients were adherent to the treatment. Among patients withdrawing treatment with MRA, the cumulative incidence of reinitiating was 36.6%. Conclusions: In a nationwide cohort of patients with HF, approximately half of the patients received MRA as third-line therapy within the first 6 months after diagnosis and approximately half of these withdrew MRA within 5 years. These findings warrant an increasing focus on retention to MRA treatment in a real-life setting.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Heart Failure
Vol/bind24
Udgave nummer3
Sider (fra-til)539-547
Antal sider9
ISSN1388-9842
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
P.R. is supported by a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d'Avenir” program FIGHT‐HF (reference: ANR‐15‐RHU‐0004).

Funding Information:
P.R. is supported by a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d'Avenir” program FIGHT-HF (reference: ANR-15-RHU-0004). Conflict of interest: none declared.

Publisher Copyright:
© 2021 European Society of Cardiology.

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