Does spironolactone improve cardiovascular outcomes and mortality across different frailty classes in HFpEF patients?
Spironolactone retains its treatment benefit in HFpEF patients regardless of their frailty status, despite frailty being associated with worse overall outcomes.
Frailty was very common in TOPCAT HFpEF participants. Greater frailty was associated with a higher risk of cardiovascular outcomes and mortality. The benefit of spironolactone on outcomes in TOPCAT was not attenuated by frailty class.
Sanders et al. (2018) studied this question.