Are aldosterone antagonists effective in patients with mild to moderate heart failure?

PROBLEM: Aldosterone antagonist therapy in patients with advanced heart failure and reduced ejection fraction is widely recommended as it decreases mortality and hospitalizations. However, it is unclear how useful this class of drugs is in patients with mild to moderate heart failure. KEY MESSAGES: The addition of aldosterone antagonists to chronic treatment of patients with mild to moderate heart failure reduces mortality and hospitalizations for heart failure decompensation. Aldosterone antagonists have a similar benefit across the spectrum of patients, regardless of their functional capacity and ejection fraction. Major clinical practice guidelines have not considered much of the existing evidence, and therefore the recommendations of these drugs are more restrictive in the type of heart failure patients. Spironolactone, a widely available and low cost drug, seems to be the best choice for the vast majority of patients with heart failure requiring an aldosterone antagonist.