Mineralocorticoid receptor antagonists in elderly patients with heart failure: a systematic review and meta-analysis

作者：Japp Deepa^*; Shah Anoop; Fisken Sheila; Denvir Martin; Shenkin Susan; Japp Alan

来源：Age and Ageing, 2017, 46(1): 18-25.

DOI：10.1093/ageing/afw138

• mineralocorticoid receptor antagonist
• aldosterone
• heart failure
• left ventricular dysfunction
• older people

Background: mineralocorticoid receptor antagonists (MRAs) improve outcomes in several populations of patients with heart failure (HF), but there has been no systematic review of MRAs in older patients.
Objectives: systematic review and meta-analysis of the efficacy and safety of MRA treatment in elderly HF patients.
Data sources: trials were identified through a literature search until 24 January 2015.
Study selection: randomised controlled trials (RCTs) of MRAs in patients with HF and/or left ventricular systolic dysfunction aged >= 65 years, with subgroup analysis of patients >= 65 years or with mean participant age >= 70 years.
Results: seven RCTs were included (total n = 8,638). Three RCTs in HF with reduced ejection fraction (HEFREF) reported overall benefit from MRA therapy with no significant treatment interaction for age; the effects of MRAs on mortality in patients >= 75 years displayed marked inter-study heterogeneity. In four RCTs of HF with preserved ejection fraction (HEFPEF), MRA treatment had no significant effect on any efficacy outcome.
Conclusions: MRAs improve clinical outcomes in selected cohorts of older patients with HEFREF but not HEFPEF. In patients >= 75 years with HEFREF, the effect of MRA treatment on overall mortality is uncertain. Further study is required in subgroups of elderly patients with both HEFREF and HEFPEF.

• 出版日期2017-1