Abstract 11413: Serum Aldosterone is Associated with Post-Discharge Events in Patients with Reduced Ejection Fraction Hospitalized for Heart Failure: Analysis from the Everest Trial
Introduction: The prognostic value of serum aldosterone [ALD] in patients admitted for acute heart failure (AHF) who were well treated with background therapy has not been well studied.
Methods: Post-hoc analysis from EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) which randomized 4,133 chronic HF patients hospitalized for AHF with EF <40% to tolvaptan vs. placebo within 48 hours of admission, and treated with standard therapy. The study population was comprised of 1850 patients randomized to placebo, who had aldosterone measured at baseline, who were treated prior to hospitalization with diuretics (97%), ACEI/ARB (84%), beta-blockers (70%) and mineralocorticoid receptor (MR) antagonists (55%). The relationship between patient characteristics and baseline ALD quartiles was assessed using a χ2, ANOVA, or Kruskal-Wallis test. Time to all cause mortality (ACM) and cardiovascular (CV) mortality or HF re-hospitalization (pre-specified endpoints) was examined with log-rank tests and Cox regression models, adjusting for baseline risk factors.
Results: Patients in the highest ALD quartile were more likely male, had previous HF hospitalizations, have lower SBP, higher BUN, and longer QRS duration. ALD was associated with increased hazards ratio in the highest quartile (relative to lowest) for ACM [1.41 (1.06-1.88)] and CV mortality or HF hospitalization [1.33 (1.06-1.68)], by multivariable Cox models.
Conclusion: Serum ALD predicts post-discharge events in patients admitted with worsening chronic HF and EF <40%, suggesting that further modulation of the renin-angiotensin-aldosterone system with MR antagonists may favorably improve outcomes.
- © 2011 by American Heart Association, Inc.