Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Spironolactone adds minimal benefit to treatment of patients with heart failure
Clinical Question
In patients hospitalized for heart failure and reduced ejection fraction, is the addition of spironolactone beneficial?
Bottom line
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
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Population-based
Synopsis
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