Spironolactone or Eplerenone Use and Outcomes

We defined the use of MRA (MRA use group) as any new or continued prescription of spironolactone or eplerenone at discharge from the index hospitalization. The detailed definitions of baseline clinical characteristics have been described previously.^{10 (link)}The primary outcome measure was a composite of all-cause death or heart failure hospitalization after discharge from the index hospitalization. Other outcome measures included heart failure hospitalization, all-cause death, cardiovascular death, sudden death, and any-cause hospitalization. Death was regarded as cardiovascular in origin unless obvious noncardiovascular causes could be identified. Cardiovascular death included death related to heart failure, sudden death, death related to stroke, and death from other cardiovascular causes. Sudden death was the unexplained death in a previously stable patient. Stroke was either ischemic or hemorrhagic that required either acute or prolonged hospitalization and had symptoms that lasted more than 24 hours. Heart failure hospitalization was due to worsening of heart failure, requiring intravenous drug therapy.^{9 (link)} Heart failure was classified according to baseline LVEF as with reduced LVEF (<40%) or with preserved LVEF (≥40%).
Laboratory tests were performed on patient admission. Missing laboratory values are presented in eTable 1 in the Supplement.