Table 1. Patient Characteristics of the Study Population in the Matched and Entire Cohort.
| Variable | No. (%) | |||||
|---|---|---|---|---|---|---|
| Propensity Score-Matched Cohort | Entire Cohort | |||||
| MRA Use (n = 1034) | No MRA Use (n = 1034) | P Value | MRA Use (n = 1678) | No MRA Use (n = 2039) | P Value | |
| Clinical Characteristic | ||||||
| Age, median (IQR), y | 80 (72-86) | 80 (73-87) | .37 | 79 (70-85) | 81 (73-87) | <.001 |
| Age ≥80 ya,b | 536 (52) | 534 (52) | .93 | 793 (47) | 1135 (56) | <.001 |
| Female sexa,b | 469 (45) | 468 (45) | .96 | 763 (45) | 905 (44) | .51 |
| BMI, mean (SD) | 23.0 (4.7) | 22.8 (4.3) | .26 | 23.0 (4.8) | 22.8 (4.2) | .20 |
| BMI ≤22b | 449 (46) | 458 (46) | .92 | 744 (47) | 893 (46) | .57 |
| Origin | ||||||
| Ischemic heart disease | 335 (32) | 323 (31) | .57 | 530 (32) | 675 (33) | .31 |
| ACSb | 61 (5.9) | 58 (5.6) | .78 | 86 (5.1) | 119 (5.8) | .34 |
| Hypertensive heart disease | 260 (25) | 269 (26) | .65 | 368 (22) | 559 (27) | <.001 |
| Cardiomyopathy | 159 (15) | 144 (14) | .35 | 318 (19) | 238 (12) | <.001 |
| Valvular heart disease | 200 (19) | 210 (20) | .58 | 338 (20) | 397 (19) | .61 |
| Other heart disease | 80 (7.7) | 88 (8.5) | .52 | 124 (7.4) | 170 (8.3) | .29 |
| Medical history | ||||||
| Previous HF hospitalizationa,b | 314 (30) | 299 (29) | .47 | 549 (33) | 768 (39) | <.001 |
| Atrial fibrillation or flutterb | 418 (40) | 447 (43) | .20 | 714 (43) | 836 (41) | .34 |
| Hypertensiona,b | 758 (73) | 761 (74) | .88 | 1135 (68) | 1555 (76) | <.001 |
| Diabetesa,b | 378 (37) | 348 (34) | .17 | 595 (35) | 797 (39) | .02 |
| Dyslipidemia | 380 (37) | 413 (40) | .14 | 612 (36) | 840 (41) | .003 |
| Previous myocardial infarctiona,b | 225 (22) | 223 (22) | .92 | 366 (22) | 470 (23) | .37 |
| Previous strokeb | 161 (16) | 139 (13) | .17 | 248 (15) | 342 (17) | .10 |
| Previous PCI or CABG | 248 (24) | 250 (24) | .92 | 392 (23) | 561 (28) | .004 |
| Current smokingb | 131 (13) | 129 (13) | .89 | 222 (13) | 230 (12) | .08 |
| VT or VF | 44 (4.3) | 41 (4.0) | .74 | 86 (5.1) | 68 (3.3) | .007 |
| Chronic kidney disease | 397 (38) | 418 (40) | .35 | 604 (36) | 1033 (51) | <.001 |
| Chronic lung diseaseb | 122 (12) | 138 (13) | .29 | 203 (12) | 285 (14) | .09 |
| Malignant neoplasm | 153 (15) | 143 (14) | .56 | 234 (14) | 301 (15) | .47 |
| Dementia | 187 (18) | 177 (17) | .56 | 281 (17) | 373 (18) | .21 |
| Social background | ||||||
| Poor medical adherence | 183 (18) | 162 (16) | .22 | 293 (17) | 335 (16) | .40 |
| With occupation | 146 (14) | 128 (12) | .24 | 261 (16) | 233 (11) | <.001 |
| Daily life activities | ||||||
| Ambulatoryb | 833 (81) | 818 (80) | .57 | 1352 (81) | 1589 (79) | .04 |
| Use of wheelchair, outdoor only | 66 (6.4) | 82 (8.0) | .16 | 109 (6.6) | 165 (8.2) | .06 |
| Use of wheelchair, outdoor and indoor | 92 (8.9) | 91 (8.9) | .97 | 141 (8.5) | 195 (9.7) | .22 |
| Bedridden | 39 (3.8) | 33 (3.2) | .49 | 59 (3.6) | 70 (3.4) | .89 |
| Vital Signs at Presentation | ||||||
| BP, mm Hg | ||||||
| Systolic, mean (SD) | 149 (34) | 149 (34) | .91 | 145 (34) | 151 (36) | <.001 |
| <90a,b | 19 (1.8) | 25 (2.4) | .36 | 48 (2.9) | 47 (2.3) | .29 |
| Diastolic, mean (SD) | 87 (24) | 85 (24) | .25 | 85 (24) | 85 (24) | .53 |
| Heart rate, mean (SD), bpm | 98 (27) | 97 (29) | .93 | 97 (27) | 95 (28) | .005 |
| <60 bpmb | 51 (4.9) | 72 (6.9) | .051 | 87 (5.2) | 163 (8.1) | <.001 |
| Rhythms at presentation | ||||||
| Sinus rhythm | 582 (56) | 583 (56) | .96 | 897 (53) | 1173 (58) | .01 |
| Atrial fibrillation or flutter | 376 (36) | 386 (37) | .65 | 652 (39) | 703 (34) | .006 |
| NYHA class III or IVa,b | 904 (87) | 913 (88) | .54 | 1456 (87) | 1766 (87) | .64 |
| Tests at admission | ||||||
| LVEF, mean (SD), % | 46 (16) | 47 (16) | .11 | 44 (16) | 48 (16) | <.001 |
| HFrEF (EF <40%)a,b | 368 (36) | 370 (36) | .93 | 722 (43) | 661 (32) | <.001 |
| BNP, median (IQR), pg/mL | 699 (381-1228) | 699 (402-1218) | .71 | 700 (381-1216) | 721 (403-1287) | .20 |
| NT-proBNP, median (IQR), pg/mL | 4640 (2189-9690) | 5530 (2947-9692) | .14 | 4810 (2427-10 773) | 6405 (3008-14 109) | .003 |
| Serum creatinine, median (IQR), mg/dL | 1.0 (0.7-1.3) | 1.1 (0.8-1.4) | <.001 | 1.0 (0.8-1.3) | 1.3 (0.9-1.9) | <.001 |
| eGFR, mean (SD), mL/min/1.73m2 | 50 (35-67) | 45 (33-59) | <.001 | 51 (37-67) | 38 (24-55) | <.001 |
| <30 mL/min/1.73m2a,b | 189 (18) | 186 (18) | .86 | 253 (15) | 725 (36) | <.001 |
| Blood urea nitrogen, median (IQR), mg/dL | 22 (16-30) | 23 (18-32) | .001 | 21 (16-29) | 26 (19-39) | <.001 |
| Albumin, mean (SD), g/dL | 3.5 (0.5) | 3.5 (0.5) | .74 | 3.5 (0.5) | 3.5 (0.5) | .04 |
| <3.0 g/dLb | 130 (13) | 122 (12) | .54 | 210 (13) | 270 (14) | .52 |
| Sodium, mean (SD), mEq/L | 139 (4.3) | 139 (4.1) | .34 | 139 (4.3) | 139 (4.1) | .16 |
| <135 mEq/Lb | 131 (13) | 101 (9.8) | .04 | 222 (13) | 211 (10) | .007 |
| Potassium, mean (SD), mEq/L | 4.1 (0.6) | 4.2 (0.6) | .003 | 4.1 (0.6) | 4.3 (0.7) | <.001 |
| ≥5.0 mEq/La | 96 (9.3) | 108 (10) | .38 | 135 (8.1) | 297 (15) | <.001 |
| Hemoglobin, mean (SD), g/dL | 11.8 (2.3) | 11.6 (2.3) | .18 | 11.9 (2.4) | 11.2 (2.3) | <.001 |
| Anemia, No. (%)a,b | 665 (64) | 670 (65) | .82 | 995 (59) | 1462 (72) | <.001 |
| MRA before the index admissiona,b | 117 (11) | 112 (11) | .73 | 522 (31) | 129 (6.3) | <.001 |
| Medications at discharge | ||||||
| ACEI/ARB and β-blocker | 464 (45) | 463 (45) | .96 | 819 (49) | 742 (36) | <.001 |
| ACEI or ARBa,b | 625 (60) | 627 (61) | .93 | 1051 (63) | 1086 (53) | <.001 |
| β-Blockera,b | 702 (68) | 703 (68) | .96 | 1203 (72) | 1266 (62) | <.001 |
| Loop diureticsa,b | 911 (88) | 908 (88) | .84 | 1541 (92) | 1474 (72) | <.001 |
| Thiazide | 40 (3.9) | 63 (6.1) | .02 | 73 (4.4) | 145 (7.1) | <.001 |
| Tolvaptan | 97 (9.4) | 92 (8.9) | .70 | 176 (10) | 214 (11) | .99 |
| Digoxin | 59 (5.7) | 58 (5.6) | .92 | 127 (7.6) | 84 (4.1) | <.001 |
| Warfarin sodium | 236 (23) | 242 (23) | .75 | 420 (25) | 504 (25) | .83 |
| DOAC | 230 (22) | 244 (24) | .46 | 379 (23) | 381 (19) | .003 |
Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin-receptor blocker; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); BNP, brain-type natriuretic peptide; BP, blood pressure; CABG, coronary artery bypass graft; DOAC, direct oral anticoagulant; EF, ejection fraction; eGFR, estimated glomerular filtration rate; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; IQR, interquartile range; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist; NT-proBNP, N-terminal-proBNP; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; VF, ventricular fibrillation; VT, ventricular tachycardia.
SI conversion factors: To convert albumin to grams per liter, multiply by 10; blood urea nitrogen level to millimoles per liter, multiply by 0.357; BNP to nanograms per liter, multiply by 1.0; eGFR to milliliters per second per meters squared, multiply by 0.0167; hemoglobin level to grams per liter, multiply by 10.0; potassium level to millimoles per liter, multiply by 1.0; serum creatinine to micromoles per liter, multiply by 88.4; and sodium to millimoles per liter, multiply by 1.0.
Variables relevant to the choice of MRA were selected for logistic regression model for developing a propensity score for the choice of MRA.
Risk-adjusting variables were selected for Cox proportional hazard models in the unmatched cohort.