Viera Stubnova‘s PhD thesis investigates the influence of spironolactone, diabetes and uric acid concentrations on survival in outpatients with heart failure, with a special focus on patients with reduced renal function.


  1. Diabetic patient with heart failure are treated with higher medication doses and have similar survival as non-diabetic patients.
  2. Spironolactone treatment is linked to improved survival in patients with heart failure and reduced renal function.
  3. Women with heart failure are at increased risk of early death if their uric acid levels are high.


Thesis: Heart-kidney interactions in outpatients with heart failure – reducing confounding by propensity score matching
Candidate: Viera Stubnova
Time: October 15, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website


(1) Diabetes does not independently predict all-cause mortality in patients with heart failure, neither in patients with nor without reduced renal function. However, diabetic patients receive higher doses of β-blockers and loop diuretics and more often receive statins than non-diabetic patients, which may to some degree explain the results.

The study includes 1448 patients with heart failure. Half of them had diabetes and were compared with propensity score matched patients without diabetes, based on 21 measured baseline variables.

(2) Heart failure patients with reduced renal function who started spironolactone treatment had 41% lower 2-year mortality than comparable patients not treated with spironolactone. This survival benefit was shown despite increased potassium levels and worsened renal function.

The study includes 170 patients who started on spironolactone at the outpatient heart clinics, and 170 comparable patients that did not start on spironolactone. 84% of the patients in the spironolactone group survived two years, compared to 73% in the non-spironolactone group

(3) High levels of uric acid are linked to increased 5-year mortality in women with heart failure but not in men. Women within the top quartile had 65% higher risk compared to women in the lowest quartile. The relationship was not influenced by renal function.

The study includes 1856 patients from the Norwegian Heart Failure Registry, with either high or low uric acid levels at baseline. Other than that, the patients in the two groups were comparable, due to strict propensity score matching.


(1) Stubnova, V., Os, I., Grundtvig, M., & Waldum-Grevbo, B. (2016). Prevalent diabetes mellitus: mortality and management in Norwegian heart failure outpatientsCardiology134(4), 413-422.

(2) Stubnova, V., Os, I., Grundtvig, M., Atar, D., & Waldum-Grevbo, B. (2017). Spironolactone treatment and effect on survival in chronic heart failure patients with reduced renal function: a propensity-matched studyCardiorenal medicine7(2), 128-136.

(3) Stubnova, V., Os, I., Høieggen, A., Solbu, M. D., Grundtvig, M., Westheim, A. S., Atar, D., & Waldum-Grevbo, B. (2019). Gender differences in association between uric acid and all-cause mortality in patients with chronic heart failureBMC Cardiovascular Disorders19(1), 4.

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