{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T12:34:04Z","timestamp":1793795644016,"version":"4.6.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Mineralocorticoid receptor antagonists are recommended as part of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). The comparative effectiveness of spironolactone and eplerenone, however, remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This was a non-interventional database study using nationwide Danish health registries, 1 January 2020 to 30 June 2025. Patients aged \u226545 years with HFrEF (ejection fraction \u226440%) initiating eplerenone or spironolactone were included. An active-comparator, new-user design and inverse-probability-of-treatment weighting based on propensity scores was used. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, heart failure hospitalization, and their composite. Weighted hazard ratios (wHRs) were estimated using Cox proportional hazards models. A total of 4550 patients initiating eplerenone and 6651 initiating spironolactone were included. Median follow-up was 2.3 years. There were 571 deaths in the eplerenone group (5.0 per 100 person-years) and 1168 in the spironolactone group (7.0 per 100 person-years). A lower risk of death was observed with eplerenone [wHR, 0.83; 95% confidence interval (CI), 0.75\u20130.93], corresponding to an absolute rate difference of \u22121.10 per 100 person-years (95% CI, \u22120.50 to \u22121.70). For secondary outcomes, wHRs were 0.89 (95% CI, 0.81\u20130.98) for cardiovascular death or heart failure hospitalization, 0.79 (95% CI, 0.67\u20130.92) for cardiovascular death, and 0.97 (95% CI, 0.87\u20131.09) for heart failure hospitalization. Effect estimates were attenuated in per-protocol analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large nationwide study, initiation of eplerenone was associated with lower risks of all-cause and cardiovascular mortality compared with spironolactone, with findings suggesting a contribution of better treatment persistence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvag030","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:57:53Z","timestamp":1777377473000},"page":"282-291","source":"Crossref","is-referenced-by-count":3,"title":["Initiation of eplerenone vs. spironolactone and all-cause mortality in HFrEF: linked database study"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-7215","authenticated-orcid":false,"given":"Henrik","family":"Svanstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Data Science and AI in Health, Statens Serum Institut , Artillerivej 5, Copenhagen S 2300 ,","place":["Denmark"]},{"name":"Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Karolinska Institutet , Maria Aspmans gata 30A, 171 64 Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Hviid","sequence":"additional","affiliation":[{"name":"Department of Data Science and AI in Health, Statens Serum Institut , Artillerivej 5, Copenhagen S 2300 ,","place":["Denmark"]},{"name":"Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2097-8466","authenticated-orcid":false,"given":"Bj\u00f6rn","family":"Pasternak","sequence":"additional","affiliation":[{"name":"Department of Data Science and AI in Health, Statens Serum Institut , Artillerivej 5, Copenhagen S 2300 ,","place":["Denmark"]},{"name":"Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Karolinska Institutet , Maria Aspmans gata 30A, 171 64 Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"2026071411421884400_pvag030-B1","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.jacc.2021.12.011","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026071411421884400_pvag030-B2","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026071411421884400_pvag030-B3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. 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