Key result
Spironolactone preserves survival in severe HF despite a ~90% increased death risk from worsening renal function.
Why the study?
Renal dysfunction or decline in renal function predicts adverse outcomes in HF and guides treatment decisions, but its influence on spironolactone efficacy was not established.
Does spironolactone reduce mortality and heart failure hospitalizations in patients with severe heart failure across different baseline renal functions and in the presence of worsening renal function?
RCT (n=1,658)
Does spironolactone reduce mortality and heart failure hospitalizations in patients with severe heart failure across different baseline renal functions and in the presence of worsening renal function?
Effect estimate: HR 1.1 (95% CI 0.79-1.5)
p-value: p=0.009
Spironolactone provides substantial mortality and hospitalization benefits in severe heart failure patients regardless of baseline renal function or the development of worsening renal function, despite an increased risk of hyperkalemia.
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Worsening renal function should not prompt spironolactone discontinuation in severe HF; confirms mortality benefit persists independent of renal decline.
Vardeny et al. (2012) conducted an RCT in Severe heart failure (n=1,658). Spironolactone vs. Placebo was evaluated on Death associated with worsening renal function (HR 1.1, 95% CI 0.79-1.5, p=0.009). Spironolactone maintained its mortality benefit in severe heart failure despite worsening renal function, which increased death risk in placebo (HR 1.9) but not spironolactone (HR 1.1; p-int=0.009).
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