Mineralocorticoids and outcome improvement in heart failure patients with and without atrial fibrillation: a systematic review and a meta-analysis.

IF 2.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Expert Review of Cardiovascular Therapy Pub Date : 2026-04-01 Epub Date: 2026-03-29 DOI:10.1080/14779072.2026.2650525

Bernadette Corica, Elisa Battigaglia, Giulio Francesco Romiti, Jacopo Francesco Imberti, Davide Antonio Mei, Niccolò Bonini, Marco Vitolo, Giuseppe Boriani

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引用次数: 0

Abstract

Background: The presence of atrial fibrillation (AF) in patients with heart failure (HF) is common and increases the risk of adverse events. Whether the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with HF varies according to AF remains to be understood.

Research design and methods: We systematically searched MEDLINE and EMBASE and included all studies reporting prevalence of AF and incidence of a composite primary outcome of cardiovascular death and HF hospitalization. Random-effects models were used to estimate pooled odds ratios (OR), 95% confidence intervals (CI), and prediction intervals (PI).

Results: Two thousand five hundred and eighty-two articles were screened, and five studies were included. Prevalence of AF in HF patients was 34.5% (95% CI: 24.8-45.8%; 95% PI: 9.4-72.8%). MRAs appeared similarly effective in reducing the risk of the primary outcome among HF patients with AF (OR: 0.91; 95% CI: 0.63-1.31) and without AF patients (OR: 0.80; 95% CI: 0.71-0.90) (subgroup difference p = 0.495). Meta-regression identified female sex, hypertension, prior HF hospitalization, and beta-blocker use as potential moderators of the risk of the primary outcome in patients with HF and AF.

Conclusions: One-third of HF patients included in RCT trials on MRAs have AF. MRAs improved outcomes with an effect that results not different in HF patients with and without AF.

Registration: The PROSPERO identification number is CRD420251007396.

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矿化皮质激素对伴有和不伴有心房颤动的心力衰竭患者预后的改善：一项系统综述和荟萃分析。

背景：心力衰竭（HF）患者房颤（AF）的存在是常见的，并增加了不良事件的风险。矿皮质激素受体拮抗剂（MRAs）对HF患者的益处是否因房颤而异仍有待了解。研究设计和方法：我们系统地检索了MEDLINE和EMBASE，并纳入了所有报道房颤患病率和心血管死亡和心衰住院这一复合主要结局发生率的研究。随机效应模型用于估计合并优势比（OR）、95%置信区间（CI）和预测区间（PI）。结果：共筛选2582篇文献，纳入5项研究。HF患者房颤患病率为34.5% （95%CI: 24.8-45.8%; 95%PI: 9.4-72.8%）。MRAs在降低合并房颤的HF患者（OR: 0.91; 95% CI: 0.63-1.31）和无房颤患者（OR: 0.80; 95% CI: 0.71-0.90）的主要结局风险方面同样有效（亚组差异p = 0.495）。meta回归发现女性、高血压、既往HF住院和β受体阻滞剂的使用是HF和AF患者主要结局风险的潜在调节因素。结论：MRAs的RCT试验中有三分之一的HF患者患有房颤。MRAs改善了结果，并且在合并房颤和不合并房颤的HF患者中效果没有差异。登记：PROSPERO识别号为CRD420251007396。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.70

自引率

0.00%

发文量

期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.