Spironolactone treatment and clinical outcomes in patients with systolic dysfunction and mild heart failure symptoms: a retrospective analysis.
ABSTRACT The effect of spironolactone on clinical outcomes in patients with mild heart failure is unclear.
We performed a retrospective analysis of 482 consecutive patients with left ventricular ejection fraction < or =40% and New York Heart Association I-II symptoms. Major cardiac event (MCE) was defined as death, left ventricular assist device implantation, or United Network of Organ Sharing 1 cardiac transplantation. Proportional hazards analysis was used to determine predictors of MCE and to derive an adjusted hazard for spironolactone therapy. Spironolactone was prescribed to 279 (58%) patients and mean follow-up was 1029 days. After controlling for predictors of clinical events, spironolactone treatment was associated with a trend for lower risk of MCE or heart failure rehospitalization (HR, 0.68; 95% CI, 0.43-1.07; P = .095). Exploration of interaction terms between medications revealed that treatment with the combination of spironolactone and thiazide diuretics was associated with lower risk of clinical events (HR, 0.32; 95% CI, 0.12-0.89; P = .029).
In subjects with mild heart failure treated with a thiazide diuretic, the use of spironolactone is associated with reduced risk of MCE or heart failure rehospitalization. A randomized controlled trial is necessary to accurately define the clinical effects of spironolactone in patients with mild heart failure.
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ABSTRACT: Aldosterone antagonists represented by nonselective spironolactone and mineralocorticoid-selective eplerenone are approved for treatment of symptomatic heart failure with reduced systolic function. Their cardioprotective, antifibrotic, and antiarrhythmic effects have been proven in animal experiments, and their effects on morbidity and mortality have been demonstrated in randomized clinical trials. Yet, they remain the most underutilized of all classes of medications for heart failure, primarily because of fear of hyperkalemia. Thorough patient screening and selection is the key for minimizing risks and optimizing benefits from these drugs. Ongoing trials will demonstrate whether the indication for aldosterone antagonists can be expanded to less severe heart failure or patients with preserved systolic function.Journal of Cardiovascular Pharmacology and Therapeutics 06/2011; 16(2):150-9. · 3.07 Impact Factor
- Heart Failure Clinics 07/2011; 7(3):xiii-xix. · 1.41 Impact Factor
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ABSTRACT: Neurohormonal blockade reduces symptoms of heart failure (HF), reverses cardiac remodeling, and improves survival, and therefore it is the mainstay in the management of chronic HF and with “pay–for–performance” expectations for physicians (1), HF patients are expected to be considered for therapy with angiotensin-converting enzyme (ACE) inhibitiors, β-blockers, and aldosterone receptor blockers (2). In this chapter, we discuss randomized clinical trials and other reports that provide evidence for neurohormonal blockade, including ACE inhibition, β-blockade, and aldosterone receptor blockade, in American College of Cardiology/American Heart Association (ACC/ AHA) stage B–C HF Figure 6.1) (3).07/2008: pages 95-128;