With a follow-up of 3.3 years, there was no difference in the primary composite outcome of CV mortality, aborted cardiac arrest, or HF hospitalization. Patients were included if they had LVEF ≥45%, findings of HF, and either a HF hospitalization or elevated BNP.
The 2014 Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) randomized 3,445 patients with mostly controlled blood pressure to spironolactone or placebo. Aldosterone antagonists had not been studied in a large RCT involving patients with HFpEF. beta blockers, ACE-inhibitors/ARBs, aldosterone antagonists), few therapies improve outcomes for HFpEF. In contrast to the multiple effective regimens for HFrEF (e.g. The efficacy of aldosterone antagonists in reducing mortality for those with HFrEF was demonstrated in RALES (1999 spironolactone) and EMPHASIS-HF (2011 eplerenone). However, it is associated with small reduction in HF hospitalizations. Among patients with heart failure with preserved ejection fraction, does spironolactone reduce CV mortality, aborted cardiac arrest, or HF hospitalizations when compared to placebo?Īmong patients with heart failure with preserved ejection fraction, spironolactone does not reduce the composite endpoint of CV mortality, aborted cardiac arrest, or HF hospitalizations when compared to placebo.
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