• Patricia Pardo-Martínez, Eduardo Barge-Caballero, Alberto Bouzas-Mosquera, Gonzalo Barge-Caballero, David Couto-Mallón, María J Paniagua-Martín, Marta Sagastagoitia-Fornie, Óscar Prada-Delgado, Javier Muñiz, Luis Almenar-Bonet, José M Vázquez-Rodríguez, and María G Crespo-Leiro.
• Servicio de Cardiología, Hospital Universitario Arquitecto Marcide, Ferrol (A Coruña), Spain.
• Eur. J. Intern. Med. 2022 Mar 1; 97: 86-94.

AimsIn the absence of previous direct comparative studies, we aimed to evaluate the effectiveness of spironolactone and eplerenone in patients with heart failure and reduced ejection fraction (HFrEF) in a real-world clinical setting.MethodsUsing Fine-Gray´s competing risk regression, we compared the clinical outcomes of 293 patients with chronic HF and left ventricular ejection fraction <40% treated with eplerenone and 293 propensity-score matched individuals treated with spironolactone. Study subjects were selected from a prospective cohort of 1404 ambulatory patients with HFrEF seen since 2010 to 2019 in a single specialized HF clinic, among which 992 received a mineralocorticoid receptor antagonist at baseline. Median follow-up was 3.95 years.ResultsNo statistically significant differences between patients treated with eplerenone versus spironolactone were observed with regard to the risk of the primary composite end-point cardiovascular death or HF hospitalization (HR 0.95; 95% CI 0.73-1.23; p= 0.677). However, eplerenone use was associated to lower cardiovascular mortality (HR 0.55; 95% CI 0.35-0.85; p= 0.008) and lower all-cause mortality (HR 0.67; 95% CI 0.47-0.95; p= 0.027). The incidence of drug suspension due to side effects (HR 0.58, 95% CI 0.40-0.85; p= 0.005) and drug suspension due to any reason (HR 0.70, 95% CI 0.51-0.97; p= 0.033) were lower among patients treated with eplerenone.ConclusionsIn this observational, real-world, propensity-score matched study of patients with HFrEF, eplerenone was associated to lower cardiovascular mortality and lower all-cause mortality than spironolactone.Copyright © 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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