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Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate
Chin, Ken Lee Collier, Timothy J. Pocock, Stuart J. Pitt, Bertram McMurray, John J. V. van Veldhuisen, Dirk J. Swedberg, Karl Vincent, John Zannad, Faiez Liew, Danny
Chin, Ken Lee
Collier, Timothy J.
Pocock, Stuart J.
Pitt, Bertram
McMurray, John J. V.
van Veldhuisen, Dirk J.
Swedberg, Karl
Vincent, John
Zannad, Faiez
Liew, Danny
Abstract
Background Increased resting heart rate is a risk factor for cardiovascular mortality and morbidity. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve cardiac sympathetic nerve activity, reduce heart rate and attenuate left ventricular remodelling. Whether or not the beneficial effects of MRA are affected by heart rate in heart failure patients with reduced ejection fraction (HFREF) is unclear. Methods We undertook a secondary analysis of data from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure study to assess if clinical outcomes, as well as the efficacy of eplerenone, varied according to heart rate at baseline. Results High resting heart rate of 80 bpm and above predisposed patients to greater risk of all outcomes in the trial, regardless of treatment allocation. The beneficial effects of eplerenone were observed across all categories of heart rate. Eplerenone reduced the risk of primary endpoint, the composite of cardiovascular death and hospitalisation for heart failure, by 30% (aHR 0.70; 95% CI 0.54–0.91) in subjects with heart rate ≥ 80 bpm, and by 48% (aHR 0.52; 95% CI 0.33–0.81) in subjects with heart rate ≤ 60 bpm. Eplerenone also reduced the risks of hospitalisation for heart failure, cardiovascular deaths and all-cause deaths independently of baseline heart rate. Conclusions Baseline heart rate appears to be an important predictor of major clinical outcome events in patients with HFREF, as has been previously reported. The benefits of eplerenone were preserved across all categories of baseline heart rate, without observed heterogeneity in the responses.
Keywords
heart rate, aldosterone antagonists, aldosterone, heart failure
Date
2019
Type
Journal article
Journal
Clinical Research in Cardiology
Book
Volume
108
Issue
7
Page Range
806-814
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled