{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T22:27:09Z","timestamp":1774304829839,"version":"3.50.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,4,17]]},"abstract":"\n Background<\/jats:title>\n \n Mineralocorticoid receptor antagonist (\n MRA<\/jats:styled-content>\n ) therapy may be beneficial to patients with atrial fibrillation (\n AF<\/jats:styled-content>\n ), but little is known about their use in patients with\n AF<\/jats:styled-content>\n and subsequent outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In order to better understand\n MRA<\/jats:styled-content>\n use and subsequent outcomes, we performed a retrospective cohort study of the contemporary\n ORBIT<\/jats:styled-content>\n \u2010\n AF<\/jats:styled-content>\n (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.\n AF<\/jats:styled-content>\n progression and cardiovascular outcomes were compared using propensity\u2010matched Cox proportional hazards modeling according to\n MRA<\/jats:styled-content>\n use at baseline and new\n MRA<\/jats:styled-content>\n use at follow\u2010up versus patients with no\n MRA<\/jats:styled-content>\n use. Among 7012 patients with nonpermanent\n AF<\/jats:styled-content>\n , 320 patients were taking\n MRA<\/jats:styled-content>\n at enrollment, and 416 patients initiated\n MRA<\/jats:styled-content>\n use during follow\u2010up. The mean patient age was 72.5\u00a0years, 56.3% were men, and 70.4% had paroxysmal\n AF<\/jats:styled-content>\n . Among all patients taking\n MRAs,<\/jats:styled-content>\n 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new\n MRA<\/jats:styled-content>\n use was not associated with reduced\n AF<\/jats:styled-content>\n progression (hazard ratio, 1.18; 95% confidence interval, 0.88\u20131.58;\n P<\/jats:italic>\n =0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02\u20131.23;\n P<\/jats:italic>\n =0.08). Results were similar for a comparison of new\n MRA<\/jats:styled-content>\n users and baseline\n MRA<\/jats:styled-content>\n users compared with nonusers.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In community\u2010based outpatients with\n AF<\/jats:styled-content>\n , the majority of\n MRA<\/jats:styled-content>\n use was for\n heart failure<\/jats:styled-content>\n and hypertension.\n MRA<\/jats:styled-content>\n use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that\n MRA<\/jats:styled-content>\n use may decrease the risk of stroke in patients with\n AF<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.007987","type":"journal-article","created":{"date-parts":[[2018,4,13]],"date-time":"2018-04-13T09:20:13Z","timestamp":1523611213000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT\u2010AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry"],"prefix":"10.1161","volume":"7","author":[{"given":"Marat","family":"Fudim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Shrader","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalia G.","family":"Blanco","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larry A.","family":"Allen","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ronald Reagan\u2010UCLA Medical Center, Los Angeles, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard J.","family":"Gersh","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine Mayo Clinic, Rochester, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R.","family":"Kowey","sequence":"additional","affiliation":[{"name":"Lankenau Institute for Medical Research, Wynnewood, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth W.","family":"Mahaffey","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaine","family":"Hylek","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan S.","family":"Go","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Oakland, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laine","family":"Thomas","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan P.","family":"Piccini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute, Durham, 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