A Composite Metric for Predicting Benefit from Spironolactone in Heart Failure with Preserved Ejection Fraction

AIMS: The TOPCAT trial showed no benefit for spironolactone in heart failure patients with preserved ejection fraction (HFpEF). Post-hoc, spironolactone helped participants from the Americas, but not Eastern Europe. Determining which patients with HFpEF could respond like TOPCAT's responders should help guide their care. We aimed to develop a TOPCAT Trial Score (TS) as a composite metric to identify such patients. METHODS AND RESULTS: FPEF scores (≥3). The cohort of real-world patients with HFpEF had even higher TS than American TOPCAT participants. CONCLUSIONS: Patients with HFpEF can be quantified by the TS to capture the likelihood of benefit from spironolactone.