Objective: The study sought to assess the impact of treatment with mineralocorticoid receptor antagonists (MRA) on long-term prognosis in patients with ventricular tachyarrhythmias and systolic heart failure (HF).

Background: Limited data investigating the prognostic value of MRA treatment following ventricular tachyarrhythmias is available.

Methods: A large retrospective registry was used including consecutive HF patients with left ventricular ejection fraction (LVEF) < 45% and index episodes of ventricular tachyarrhythmias from 2002 to 2015. The primary endpoint was all-cause mortality at 3 years. Statistics comprised of Kaplan-Meier and multivariable Cox regression analyses.

Results:  748 patients were included, 20% treated with MRA and 80% without. At 3 years, treatment with MRA was not associated with the primary endpoint of all-cause mortality (22% vs. 24%, log-rank p=0.968; HR=1.008; 95% CI 0.690-1.472; p=0.968). Accordingly, risk of the composite endpoint (28% vs. 27%; HR = 1.131; 95% CI 0.806 – 1.589; p=0.476), first cardiac rehospitalization (24% vs. 22%; HR = 1.139; 95% CI 0.788 – 1.648; p=0.489) were not affected by treatment with MRA. Finally, prognosis of patients treated with spironolactone and eplerenone was comparable.

Conclusion: In patients with ventricular tachyarrhytmias, treatment with MRA was not associated with long-term prognostic endpoints at 3 years.