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- Girerd, N., et al.
(författare)
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Serum aldosterone is associated with mortality and re-hospitalization in patients with reduced ejection fraction hospitalized for acute heart failure: analysis from the EVEREST trial
- 2013
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842. ; 15:11, s. 1228-1235
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Post-discharge morbidity and mortality for acute heart failure (AHF) patients remains high. Although the adverse effects of neurohormonal activation are well known in chronic HF, the prognostic significance of serum aldosterone in patients hospitalized for AHF has not been well studied. METHODS AND RESULTS: A secondary analysis was carried out of the placebo arm (n = 1850) from the EVEREST trial which had aldosterone measured at baseline. All patients were hospitalized for worsening HF and had an LVEF <40%. The median follow-up was 9.9 months. The association between serum aldosterone levels at baseline and the independently adjudicated outcomes [all-cause mortality (ACM) and the combined outcome of cardiovascular mortality (CVM) and HF re-hospitalization] were explored with multivariable Cox models. Median aldosterone levels increased during the hospital stay from 11 ng/dL at baseline to 15 ng/dL at discharge (P < 0.001) and remained increased after discharge (16 ng/dL at 24 weeks, P < 0.001). After adjusting for potential confounders, higher baseline aldosterone levels were associated with an increased risk for ACM and CVM or HF re-hospitalization [hazard ratio (HR) 1.49, 95% confidence intrerval (CI) 1.11-1.99; and HR 1.40, 95% CI 1.11-1.78, respectively, in the highest quartile when compared with the lowest]. CONCLUSION: In patients with LVEF <40% hospitalized for AHF and receiving standard therapy, serum aldosterone levels correlated with worse post-discharge outcomes. Aldosterone levels increase during AHF hospitalization and remain increased long after discharge. These results suggest that further modulation of the renin-angiotensin-aldosterone system in patients admitted with worsening HF might favourably improve post-discharge outcomes.
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| 2. |
- Rossignol, P., et al.
(författare)
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Incidence, Determinants, and Prognostic Significance of Hyperkalemia and Worsening Renal Function in Patients with Heart Failure Receiving the Mineralocorticoid Receptor Antagonist Eplerenone or Placebo Additional to Optimal Medical Therapy: Results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)
- 2014
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Ingår i: Circulation Heart Failure. - 1941-3289 .- 1941-3297. ; 7:1, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: -Mineralocorticoid receptor antagonists (MRA) improve outcomes in patients with systolic heart failure (HF), but may induce a worsening of renal function (WRF) and/or hyperkalemia (HK). We assessed the risk factors for MRA-related WRF and for HK, as well as the association between HK and WRF with clinical outcomes in the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) METHODS AND RESULTS: -Serial changes in estimated glomerular filtration rate (eGFR) and in serum potassium were available in 2737 patients during a median 21-month follow-up. HK variably defined as serum K>4.5, 5 or 5.5 mmol/L occurred in 74.7 %, 32.5 %, and 8.9 % of EMPHASIS-HF patients, respectively. WRF defined as a decrease in eGFR > 20% or >30% from baseline occurred in 27% and 14% of patients, respectively. Patients assigned eplerenone displayed modest and early but significant and persistent i) rise in serum potassium, and ii) reduction in eGFR compared with placebo. In multivariate analyses, eplerenone was associated with a higher incidence of WRF and HK, which were interrelated and also associated with baseline patient characteristics (e.g. age >/=75 years, hypertension, diabetes, non-white race, ejection fraction <30%, and treatment with an antiarrythmics drug or loop diuretic). Eplerenone retained its survival benefits, without any significant interaction with the association between HK >5.5 mmol/l only and WRF and worse outcomes. CONCLUSIONS: -In HF patients receiving optimal therapy, WRF and HK were more frequent when eplerenone was added, but their occurence did not eliminate the survival benefit of eplerenone. Clinical Trial Registration-URL: http://www.ClinicalTrials.gov number. Unique identifier: NCT00232180.
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