Spironolactone in patients with heart failure and preserved ejection fraction.

Abstract

OBJECTIVES:

Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF.

PATIENTS AND METHODS:

We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis.

RESULTS:

We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001).

CONCLUSIONS:

For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia.

• Authors: C Sánchez-Sánchez, H F Mendoza-Ruiz de Zuazu, F Formiga, L Manzano, L M Ceresuela, M Carrera-Izquierdo, Á González Franco, F Epelde-Gonzalo, J M Cerqueiro-González, M Montero-Pérez-Barquero, en representación de los investigadores del registro RICA del Grupo de Trabajo FEMI de Insuficiencia Cardiaca y Fibrilación Auricular
• Journal: Revista clinica espanola (Rev Clin Esp (Barc)) 2015 Aug-Sep Vol. 215 Issue 6 Pg. 301-7 ISSN: 2254-8874 [Electronic] Spain
• Vernacular Title: Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada.
• PMID: 25680482 (Publication Type: Journal Article)
• Copyright: Copyright © 2015. Published by Elsevier España, S.L.U.