SynthesisClinical research in cardiology : official journal of the German Cardiac Society2019
Impact of mineralocorticoid receptor antagonists on the risk of sudden cardiac death in patients with heart failure and left-ventricular systolic dysfunction: an individual patient-level meta-analysis of three randomized-controlled trials.
Synthesis in Clinical research in cardiology : official journal of the German Cardiac Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 83 citations in OpenAlex.
- The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy.The international journal of cardiovascular imaging · 2023Trial
- Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy.PloS one · 2023Trial
- Effect of sacubitril/valsartan on investigator-reported ventricular arrhythmias in PARADIGM-HF.European journal of heart failure · 2022Trial
- Influence of sex, age and race on coronary and heart failure events in patients with diabetes and post-acute coronary syndrome.Clinical research in cardiology : official journal of the German Cardiac Society · 2021Trial
- Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF.European heart journal · 2021Trial
- Eplerenone in patients with myocardial infarction and "mid-range" ejection fraction: An analysis from the EPHESUS trial.Clinical cardiology · 2019Trial
- Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Trial
- Article
- Impact of mineralocorticoid receptor antagonists on the risk of sudden cardiac death across cardio-kidney-metabolic diseases: A meta-analysis of randomized clinical trials.European journal of heart failure · 2025Article
- The Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Implantable Cardioverter Defibrillator Shocks in Heart Failure Patients Undergoing Diuretic Therapy.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Article
- Predictors of ventricular tachyarrhythmia in patients with a wearable cardioverter defibrillator: an international multicenter registry.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Article
- Drug therapy and catheter ablation for management of arrhythmias in continuous flow left ventricular assist device's patients: a Clinical Consensus Statement of the European Heart Rhythm Association and the Heart Failure Association of the ESC.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Ventricular arrhythmias in acute heart failure: a clinical consensus statement of the Association for Acute CardioVascular Care, the European Heart Rhythm Association, and the Heart Failure Association of the European Society of Cardiology.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Digoxin is Not Related to Mortality in Patients with Heart Failure: Results from the SELFIE-TR Registry.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024Observational
- Anti-Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy and Their Role in the Prevention of Sudden Cardiac Death: From Beta-Blockers to Sodium-Glucose Cotransporter 2 Inhibitors and Beyond.Journal of clinical medicine · 2024Review
- Evidence for Aldosterone Antagonism in Heart Failure.Cardiac failure review · 2024Review
- Sudden Death in Men Versus Women with Heart Failure.Current heart failure reports · 2023Review
- Finerenone and effects on mortality in chronic kidney disease and type 2 diabetes: a FIDELITY analysis.European heart journal. Cardiovascular pharmacotherapy · 2023Article
- Follow-up of CRT-D patients downgraded to CRT-P at the time of generator exchange.Frontiers in cardiovascular medicine · 2023Article
- Diabetes Mellitus and Heart Failure.Journal of personalized medicine · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 6 institutions in 5 countries.
Funding
Abstract
backgroundSudden cardiac death (SCD) is an important cause of death in patients with left-ventricular systolic dysfunction (LVSD). Mineralocorticoid receptor antagonists (MRAs) may attenuate this risk. We aimed to assess the impact of MRAs on SCD in patients with LVSD.
methodsA fixed-effect meta-analysis at individual patient-level was performed using 11,032 patients recruited in three placebo-controlled randomized trials: Randomized Aldactone Evaluation Study (RALES), Eplerenone Post Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), and Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Treatment effect was determined using a Cox proportional hazards model stratified by study.
resultsPatients receiving MRAs were at lower risk of SCD compared with placebo-treated patients after a mean follow-up of 18 months (HR 0.77, 95% CI 0.66-0.89). This effect was consistent across trials and did not change substantially after adjustment for 14 baseline co-variates. Moreover, the benefits of MRAs were consistent across study subgroups, except for a greater effect in those < 65 years old and those using beta-blockers. Using stratified analyses, we also found a consistent effect in relevant subsets of patient defined by heart failure cause, NYHA class or LVEF ≤ 35%.
conclusionsMRAs reduce the risk for SCD by 23% in patients with heart failure and LVSD. In these patients, the use of MRAs, on top of other evidence-based medications, should be optimized. It might be useful to re-assess the benefit of implantable cardiac defibrillator (ICD) placement, as ICD treatment effect was evaluated in trials enrolling patients not receiving MRAs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.