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Background  Mineralocorticoid receptor antagonist ( MRA ) therapy may be beneficial to patients with atrial fibrillation ( AF ), but little is known about their use in patients with  AF  and subsequent outcomes.    Methods and Results  In order to better understand  MRA  use and subsequent outcomes, we performed a retrospective cohort study of the contemporary  ORBIT ‐ AF  (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.  AF  progression and cardiovascular outcomes were compared using propensity‐matched Cox proportional hazards modeling according to  MRA  use at baseline and new  MRA  use at follow‐up versus patients with no  MRA  use. Among 7012 patients with nonpermanent  AF , 320 patients were taking  MRA  at enrollment, and 416 patients initiated  MRA  use during follow‐up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal  AF . Among all patients taking  MRAs,  434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new  MRA  use was not associated with reduced  AF  progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58;  P =0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23;  P =0.08). Results were similar for a comparison of new  MRA  users and baseline  MRA  users compared with nonusers.    Conclusions  In community‐based outpatients with  AF , the majority of  MRA  use was for  heart failure  and hypertension.  MRA  use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that  MRA  use may decrease the risk of stroke in patients with  AF .

journal of the american heart association

Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the  ORBIT ‐ AF  (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry