Lee, Chia-ChenChia-ChenLeeTe-Wei Kuan, DavidDavidTe-Wei KuanChang, Kai-ChunKai-ChunChangZHENG-WEI CHENJEN-FANG CHENGTING TSE LINLIAN-YU LINCHO-KAI WU2025-01-092025-01-092024https://pubmed.ncbi.nlm.nih.gov/39734408/https://scholars.lib.ntu.edu.tw/handle/123456789/724691To clarify the efficacy of mineralocorticoid receptor antagonists (MRA) and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) in heart failure with mildly reduced ejection fraction (HFmrEF). This study assessed the association between these medications and outcomes in HFmrEF using data from the National Taiwan University Hospital-integrated Medical Database. The primary outcome was cardiovascular mortality/heart failure hospitalization (HHF). Inverse probability of treatment weighting balanced baseline patient characteristics. The exposure of primary interest was use of MRA and use of RASI/ARNI, while the non-user group was also likely to receive other heart failure medication treatment. Among 2,584 HFmrEF patients, 17% received MRA and 43% received RASI/ARNI. Predictors of MRA use included older age, slightly higher ejection fraction, and lower NT-proBNP level. RASI/ARNI use was predicted by higher BMI, lower NT-proBNP level, normal uric acid and potassium levels. MRA use was not associated with a lower risk of cardiovascular death [hazard ratio = 0.89, 95% confidence interval (CI): 0.78-1.02] or HHF (hazard ratio = 1.01, 95% CI: 0.94-1.09). Conversely, RASI//ARNI use was linked to a lower risk of cardiovascular death (hazard ratio = 0.82, 95% CI: 0.71-0.94) but not HHF (hazard ratio = 0.995, 95% CI: 0.924-1.07). Landmark analysis showed no significant difference in outcomes for follow-up durations exceeding 2 years. MRA had a neutral effect on cardiovascular death and HHF, while RASI/ARNI was associated with a lower risk of cardiovascular death. RASI/ARNI may be more beneficial than MRA for HFmrEF patients. Regular re-evaluation is essential to adjust heart failure treatment.enHFmrEFMRA (magnetic resonance angiography)angiotensin receptor neprilysin inhibitorcardiovascular outcomesreninangiotensin system inhibitor[SDGs]SDG3journal article10.3389/fphar.2024.150732639734408