Spironolactone significantly reduced the composite of all-cause death and heart failure rehospitalization compared to no treatment in patients with HFmrEF (21.3% vs 34.5%, p=0.014).
Observational (n=279)
Does spironolactone reduce the composite of all-cause death and heart failure rehospitalization in patients with heart failure with mid-range ejection fraction?
Spironolactone treatment significantly reduces the composite of all-cause death and heart failure rehospitalization and improves quality of life in patients with HFmrEF compared to no treatment, with 25 mg daily being as effective as 50 mg daily.
Tasa de eventos absoluta: 21.3% vs 34.5%
valor p: p=.014
AIM: The treatment effects of spironolactone on heart failure with reduced (HFrEF LVEF <40%) and preserved (HFpEF LVEF ≥50%) ejection fraction are well characterized. It is not clear whether heart failure patients with mid-range ejection fraction (HFmrEF, LVEF 40-49%) benefit from spironolactone. The present study aims to evaluate the efficacy of spironolactone in HFmrEF patients. METHOD: This study compared a high dosage of spironolactone (50 mg daily), a low dosage of spironolactone (25 mg daily), and an untreated group for the prevention of major adverse cardiovascular events (MACE) in 279 patients admitted to hospital diagnosed with HFmrEF. RESULTS: With a mean follow-up duration of 1 year, the death and HF-rehospitalization rate demonstrated significantly lower incidence in those taking spironolactone, compared with the untreated group (21.3% vs 34.5%, p = .014, respectively). Further analysis showed no difference between two spironolactone groups (21.8% vs 20.7%, p = .861). Kaplan-Meier analysis of outcome-free survival illustrated a significant difference in survival rate among three groups (log-rank testing, p = .045). Compared with the baseline level, patients receiving 25 mg spironolactone had a lower physical score (p < .05) at 1-year follow-up. MLHFQ total scores in the two spironolactone groups markedly improved compared with the untreated group (p < .001); similar results were observed in the MLHFQ physical scores (p = .025, .001, respectively) and emotional sub-scale (p = .023, .011, respectively); however, paired comparison between the two spironolactone groups showed no difference. CONCLUSIONS: In patients with HFmrEF, treatment with spironolactone significantly reduced the incidence of the primary composite outcomes of all-cause death, and rehospitalization for the management of heart failure compared with placebo, and a high dosage of spironolactone did not show trends of reduction in MACE.
Xin et al. (Wed,) conducted a observational in Heart failure with mid-range ejection fraction (HFmrEF) (n=279). Spironolactone vs. Untreated group was evaluated on Composite outcomes of all-cause death and rehospitalization for the management of heart failure (p=.014). Spironolactone significantly reduced the composite of all-cause death and heart failure rehospitalization compared to no treatment in patients with HFmrEF (21.3% vs 34.5%, p=0.014).