The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.
Ceasing use of mineralocorticoid receptor antagonists (MRA) in patients with heart failure (HF) and hyperkalemia was associated with an increased risk for mortality, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.
Investigators of this retrospective observational study sought to assess the effects of MRA cessation on the risk-benefit balance in patients with HF and hyperkalemia (serum potassium reaching ≥5.1 mmol/L at least twice within 12 months). Among 15,442 eligible patients identified in a Japanese hospital claims database, 2,220 patients were prescribed MRA therapy. Researchers used propensity score matching to assess relative mortality risk for patients with HF and hyperkalemia with or without MRA cessation. The risk-benefit balance was determined using a cubic spline regression curve analysis for each serum potassium strata.
At 12 months, cumulative incidence of MRA cessation was 52.7%, and MRA dose reduction was 6.5%. The mortality rate in the MRA cessation group was significantly higher vs the group without MRA cessation (hazard ratio, 1.21; 95% CI, 1.01-1.44; P =.038). Patients with serum potassium levels below 5.7 mmol/L showed an increase in relative mortality risk for MRA cessation vs without.
The study data indicated that patients with HF and hyperkalemia had a high MRA cessation rate, despite an increased mortality risk associated with patients who ceased MRA use at serum potassium levels below 5.7 mmol/L.
“Careful consideration of risk-benefit balance is needed for MRA cessation in hyperkalemic HF patients,” the study authors said.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Kohsaka S, Kikuchi T, Mogalli R, Ishizu T, Okami S, Yajima T. Mortality risk associated with cessation of mineralocorticoid receptor antagonists in heart failure patients and hyperkalemia; a real-world study from a nationwide administrative database. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P1136.
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