Withdrawal of Mineralocorticoid Receptor Blockers is Associated with Worse Prognosis in Patients with Acute Decompensated Heart Failure

Backgrounds: Heart failure is an increased burden all over the world. The post-discharge mortality and rehospitalization rate are unacceptably high despite the advances in management of chronic heart failure, such as evidence based medication and mechanical device. Although angiotensin converting enzyme inhibitors, angiotensin receptor blockers and additional mineralocorticoid receptor blockers (MRA) has sufficient evidences for improving outcome in patients with acute decompensated heart failure (ADHF), limited studies have evaluated the impact of continuation or discontinuation of MRA on mortality. Methods: Acute Decompensated Heart Failure Syndromes (ATTEND) registry enrolled 4842 patients admitted with ADHF. Outcomes data were retrospectively collected and analyzed according to whether MRA was continued, withdrawn, or not started. Results: Among 4842, there were 749 (15.5%) who were receiving MRA before admission and continued on therapy, 1478 (30.5%) newly started, 225 (4.7%) in which therapy was withdrawn, and 2390 (49.4%) were not receiving MRA before and after admission. Continuation of MRA was associated with a significantly lower risk of post-discharge death (P < .001) and death compared with no MRA. In contrast, withdrawal of MRA was associated with a substantially higher risk of mortality compared with those continued on MRA (P < .001). Conclusions: Not only the continuation but also addition of MRA therapy in patients with ADHF is associated with lower post-discharge mortality risk. In contrast, withdrawal of MRA therapy might be associated with poor outcome.