Abstract
26-A-19496-ACC CLINICAL OUTCOMES AMONG HFPEF PATIENTS ON SPIRONOLACTONE VS EPLERENONE: A REAL WORLD PROPENSITY MATCHED ANALYSIS
Journal of the American College of Cardiology, Vol.87(13 Supplement), p.A635
04/2026
DOI: 10.1016/j.jacc.2026.02.1675
Abstract
Background
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of heart failure cases and is challenging to treat, with few effective therapies. Mineralocorticoid receptor antagonists (MRAs) are commonly used, but data comparing eplerenone and spironolactone in HFpEF are limited. This study evaluates the clinical outcomes of eplerenone versus spironolactone in HFpEF patients using real-world data.
Methods
This retrospective cohort study utilized the TriNetX Research Network to compare outcomes in patients with HFpEF treated with eplerenone (n = 6,406) versus spironolactone (n = 385,794). Propensity score matching for demographics, comorbidities, and medications was done. The index event was the first documentation of diastolic heart failure with MRA initiation. Primary outcomes were all-cause mortality and hospitalization; secondary outcomes included progression to HFrEF, stroke, myocardial infarction, and acute heart failure exacerbation.
Results
After matching, 6,397 patients per cohort were well-balanced. Over a mean follow-up of 2.2 years, eplerenone was associated with lower all-cause mortality (21.2% vs. 26.7%), hospitalization (38.5% vs. 44.9%), progression to HFrEF (3.0% vs. 4.3%), acute MI (13.1% vs. 14.9%), and heart failure exacerbation (34.6% vs. 41.8%) (all p<0.01). Stroke rates were similar.
Conclusion
Eplerenone was associated with superior outcomes versus spironolactone in HFpEF, warranting confirmation in prospective trials.
Details
- Title: Subtitle
- 26-A-19496-ACC CLINICAL OUTCOMES AMONG HFPEF PATIENTS ON SPIRONOLACTONE VS EPLERENONE: A REAL WORLD PROPENSITY MATCHED ANALYSIS
- Creators
- God-dowell O. Odukudu - University of IowaDivine Dele - University of IowaAdemola Ajibade - University of IowaFrancois Barrett - University of IowaChinelo Madekwe - University of IowaHenry Ariri - University of IowaAbdulkareem Murtala - University of IowaEphesians Nkwetta Anutebeh - University of IowaOgheneakpobor Ubogun - University of IowaOmowunmi Fakorede - University of IowaInnocent Lutaya - University of IowaFaoziat Omokanyinsola Ganiyu - University of IowaVictory Odukudu - University of IowaOghenekevwe Odogun - University of IowaTeddy Ikhuoriah - University of IowaSamed Obeng - University of IowaZachary Morrow - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the American College of Cardiology, Vol.87(13 Supplement), p.A635
- DOI
- 10.1016/j.jacc.2026.02.1675
- ISSN
- 0735-1097
- Language
- English
- Date published
- 04/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985147061602771
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