title: Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure.
abstract: BACKGROUND
  Several studies have definitively shown the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF). However, very few prior studies examined the relationship between the timing of initiation of MRAs and prognosis. In addition, on this topic, there is no information regarding the specific population of patients suffering a first episode of decompensated congestive HF.
  
  
  METHODS
  We studied a homogenous cohort of patients discharged alive from our hospital after a first episode of decompensated congestive HF, in order to clarify the association between time of aldosterone receptor antagonist (ARA) initiation (within the first 90 days after hospital discharge) and mortality. Our population was composed of a series of consecutive patients. All-cause mortality was compared between patients who initiated MRAs at discharge (early group) and those who initiated MRAs one month later and up to 90 days after discharge (delayed group). We used prescription time distribution matching to control for survival difference between groups.
  
  
  RESULTS
  The early and delayed groups consisted of 365 and 320 patients, respectively. During the one-year follow-up, a significant difference in mortality was demonstrated between groups. Adjusted hazard ratios (HRs) for early versus delayed initiation were 1.72 (95% confidence interval (CI) 0.96 to 2.84) at six months, and 1.93 (95% CI 1.18 to 3.14) at one year.
  
  
  CONCLUSIONS
  Delay of MRA initiation up to 30 to 90 days after discharge implies a significant increase in mortality compared with MRA initiation at discharge, after a first episode of decompensate congestive HF.
authors.affiliation: Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy rossi.rosario@unimore.it.
authors.forename: Rosario
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Crupi
authors.affiliation: Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Coppi
authors.affiliation: Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy.
authors.forename: Daniel
authors.initials: D
authors.lastname: Monopoli
authors.affiliation: Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Sgura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002191:Canrenoic Acid / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011379:Prognosis; D013148:Spironolactone / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D002191:Canrenoic Acid
keywords: ACE-I: angiotensinconverting enzyme inhibitor; AMI: acute myocardial infarction; ARA: aldosterone receptor antagonist; ARB: angiotensin receptor antagonist; HF: heart failure; LV: left ventricular; MRA: mineralocorticoid receptor antagonist; RAAS: renin–angiotensin–aldosterone system; aldosterone; mortality; prognosis