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Spironolactone adds minimal benefit to treatment of patients with heart failure

Question clinique

In patients hospitalized for heart failure and reduced ejection fraction, is the addition of spironolactone beneficial?

L’Essentiel

This observational study found a small benefit when spironolactone was added to pre-existing therapy, but the benefit was not impressive. This result echoes that of a previous analysis of more rigorous randomized controlled trials. 2b

Référence

Bayoumi E, Lam PH, Dooley DJ, et al. Spironolactone and outcomes in older patients with heart failure and reduced ejection fraction. Am J Med 2019;132(1):71-80.

Plan de l'etude: Cohort (prospective)

Financement: Government

Cadre: Population-based

Sommaire

This study included 8206 older patients (average age 75 years) in a US registry who were admitted for heart failure with a reduced ejection fraction not previously treated with spironolactone. This was not a randomized controlled trial: The authors attempted to match patients who did or didn't receive spironolactone using propensity matching. In this case, they matched patients according to baseline renal function. In this more real-world approach to determine the benefit of spironolactone, spironolactone treatment was associated with a lower rate of readmission for heart failure, and of the combined outcome of mortality or hospitalization. However, the effects were modest and not nearly as good as those seen in randomized trials or in younger patients.

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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