Prognostic Value of Albuminuria and Influence of Spironolactone in Heart Failure With Preserved Ejection Fraction
Key result
Spironolactone reduced albuminuria by 39% vs placebo (geometric mean ratio 0.61; 95% CI 0.49-0.77), and reducing UACR by 50% lowered heart failure hospitalization (HR 0.90; P=0.017).
Why the study?
Does spironolactone reduce albuminuria, and does albuminuria predict adverse events in patients with heart failure with preserved ejection fraction?
Population
1175 participants from the Americas with heart failure with preserved ejection fraction from the TOPCAT…
Comparison
Spironolactone vs Placebo
Design
Cohort
Follow-up
1 year for UACR change
Authors
Discussion
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Implication
Spironolactone-linked albuminuria reduction may lower HF hospitalization risk; hypothesis-generating and should not yet change HFpEF practice.
Study Design
Type
RCT (n=1,175)
Multicenter
Yes
Structured PICO
Does spironolactone reduce albuminuria, and does albuminuria predict adverse events in patients with heart failure with preserved ejection fraction?
P
Population
1175 participants from the Americas with heart failure with preserved ejection fraction (HFpEF) from the TOPCAT study, with baseline urinary albumin:creatinine ratio (UACR) measurements. 35% had microalbuminuria, 13% had macroalbuminuria, and 80% were receiving ACEi/ARB.
I
Intervention
Spironolactone
C
Comparator
Placebo
O
Outcome
Composite of cardiovascular death, aborted cardiac arrest, or heart failure hospitalizationcomposite
Main Result
Effect estimate: HR 1.67 (95% CI 1.22-2.28)
Albuminuria is an independent predictor of adverse cardiovascular outcomes in HFpEF, and spironolactone significantly reduces albuminuria, which is associated with improved clinical outcomes.
Cite This Study
Selvaraj et al. (2018) conducted an RCT in Heart failure with preserved ejection fraction (n=1,175). Spironolactone vs. Placebo was evaluated on Cardiovascular death, aborted cardiac arrest, or heart failure hospitalization (HR 1.67, 95% CI 1.22-2.28). Spironolactone reduced albuminuria by 39% vs placebo (geometric mean ratio 0.61; 95% CI 0.49-0.77), and reducing UACR by 50% lowered heart failure hospitalization (HR 0.90; P=0.017).