Pardo Martínez, PatriciaBarge-Caballero, EduardoBouzas-Mosquera, AlbertoBarge-Caballero, GonzaloCouto-Mallón, DavidPaniagua-Martín, María J.Sagastagoitia-Fornie, MartaPrada-Delgado, ÓscarMuñiz, JavierAlmenar-Bonet, LuisVázquez Rodríguez, José ManuelCrespo-Leiro, María Generosa2022-02-182022-01-06Pardo-Martínez P, Barge-Caballero E, Bouzas-Mosquera A, Barge-Caballero G, Couto-Mallón D, Paniagua-Martín MJ, et al. Real world comparison of spironolactone and eplerenone in patients with heart failure. Eur J Intern Med.2022;97:86-940953-6205http://hdl.handle.net/2183/29814[Abstract] Aims. In 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. Methods. Using 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. Results. No 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. Conclusions. In 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.engCreative Commons Attribution-NonCommercial-NoDerivs 4.0 International Licence (CC-BY-NC-ND 4.0)http://creativecommons.org/licenses/by-nc-nd/4.0/Heart failureReduced ejection fractionSpironolactoneEplerenoneSurvivalOutcomesjournal articleopen access