PURPOSE: Heart failure (CHF) guidelines recommend mineralocorticoid receptor antagonists for all symptomatic patients treated with a combination of ACE inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers. As opposed to both eplerenone trials, patients in RALES (spironolactone) received almost no beta-blockers. Since pharmacological properties differ between eplerenone and spironolactone, the prognostic benefit of spironolactone added to this baseline combination therapy needs clarification. METHODS: We included 4,832 CHF patients with chronic systolic dysfunction from the Norwegian Heart Failure Registry and the heart failure outpatients' clinic of the University of Heidelberg. Propensity scores for spironolactone receipt were calculated for each patient and used for matching to patients without spironolactone. RESULTS: During a total follow-up of 17,869 patient-years, 881 patients (27.0 %) died in the non-spironolactone group and 445 (28.4 %) in the spironolactone group. Spironolactone was not associated with improved survival, neither in the complete sample (HR 0.82; 95 % CI 0.64-1.07; HR 1.03; 95 % CI 0.88-1.20; multivariate and propensity score adjusted respectively), nor in the propensity-matched cohort (HR 0.98; 95 % CI 0.82-1.18). CONCLUSION: In CHF outpatients we were unable to observe an association between the use of spironolactone and improved survival when administered in addition to a combination of ACE/ARB and beta-blockers.
PURPOSE:Heart failure (CHF) guidelines recommend mineralocorticoid receptor antagonists for all symptomatic patients treated with a combination of ACE inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers. As opposed to both eplerenone trials, patients in RALES (spironolactone) received almost no beta-blockers. Since pharmacological properties differ between eplerenone and spironolactone, the prognostic benefit of spironolactone added to this baseline combination therapy needs clarification. METHODS: We included 4,832 CHFpatients with chronic systolic dysfunction from the Norwegian Heart Failure Registry and the heart failure outpatients' clinic of the University of Heidelberg. Propensity scores for spironolactone receipt were calculated for each patient and used for matching to patients without spironolactone. RESULTS: During a total follow-up of 17,869 patient-years, 881 patients (27.0 %) died in the non-spironolactone group and 445 (28.4 %) in the spironolactone group. Spironolactone was not associated with improved survival, neither in the complete sample (HR 0.82; 95 % CI 0.64-1.07; HR 1.03; 95 % CI 0.88-1.20; multivariate and propensity score adjusted respectively), nor in the propensity-matched cohort (HR 0.98; 95 % CI 0.82-1.18). CONCLUSION: In CHF outpatients we were unable to observe an association between the use of spironolactone and improved survival when administered in addition to a combination of ACE/ARB and beta-blockers.
Authors: S T Normand; M B Landrum; E Guadagnoli; J Z Ayanian; T J Ryan; P D Cleary; B J McNeil Journal: J Clin Epidemiol Date: 2001-04 Impact factor: 6.437
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Sharon Ann Hunt; William T Abraham; Marshall H Chin; Arthur M Feldman; Gary S Francis; Theodore G Ganiats; Mariell Jessup; Marvin A Konstam; Donna M Mancini; Keith Michl; John A Oates; Peter S Rahko; Marc A Silver; Lynne Warner Stevenson; Clyde W Yancy Journal: Circulation Date: 2009-03-26 Impact factor: 29.690
Authors: John J V McMurray; Stamatis Adamopoulos; Stefan D Anker; Angelo Auricchio; Michael Böhm; Kenneth Dickstein; Volkmar Falk; Gerasimos Filippatos; Cândida Fonseca; Miguel Angel Gomez-Sanchez; Tiny Jaarsma; Lars Køber; Gregory Y H Lip; Aldo Pietro Maggioni; Alexander Parkhomenko; Burkert M Pieske; Bogdan A Popescu; Per K Rønnevik; Frans H Rutten; Juerg Schwitter; Petar Seferovic; Janina Stepinska; Pedro T Trindade; Adriaan A Voors; Faiez Zannad; Andreas Zeiher Journal: Eur Heart J Date: 2012-05-19 Impact factor: 29.983
Authors: Bertram Pitt; Willem Remme; Faiez Zannad; James Neaton; Felipe Martinez; Barbara Roniker; Richard Bittman; Steve Hurley; Jay Kleiman; Marjorie Gatlin Journal: N Engl J Med Date: 2003-03-31 Impact factor: 91.245
Authors: Colin Berry; Niamh F Murphy; Niamh Murphy; Giuseppe De Vito; Stuart Galloway; Alison Seed; Carol Fisher; Naveed Sattar; Patrick Vallance; W Sewart Hillis; John McMurray Journal: Eur J Heart Fail Date: 2006-11-27 Impact factor: 15.534
Authors: David N Juurlink; Muhammad M Mamdani; Douglas S Lee; Alexander Kopp; Peter C Austin; Andreas Laupacis; Donald A Redelmeier Journal: N Engl J Med Date: 2004-08-05 Impact factor: 91.245
Authors: Kenneth Dickstein; Alain Cohen-Solal; Gerasimos Filippatos; John J V McMurray; Piotr Ponikowski; Philip Alexander Poole-Wilson; Anna Strömberg; Dirk J van Veldhuisen; Dan Atar; Arno W Hoes; Andre Keren; Alexandre Mebazaa; Markku Nieminen; Silvia Giuliana Priori; Karl Swedberg Journal: Eur Heart J Date: 2008-09-17 Impact factor: 29.983
Authors: Lutz Frankenstein; Svenja Seide; Tobias Täger; Katrin Jensen; Hanna Fröhlich; Andrew L Clark; Mirjam Seiz; Hugo A Katus; Paul Nee; Lorenz Uhlmann; Huseyin Naci; Dan Atar Journal: Heart Fail Rev Date: 2020-03 Impact factor: 4.214
Authors: W von Scheidt; C Zugck; M Pauschinger; R Hambrecht; O Bruder; A Hartmann; M Rauchhaus; R Zahn; J Brachmann; U Tebbe; T Neumann; R H Strasser; M Böhm; S Störk; M Hochadel; P Heidemann; J Senges Journal: Clin Res Cardiol Date: 2014-07-23 Impact factor: 5.460
Authors: Christopher J Rush; Ross T Campbell; Pardeep S Jhund; Mark C Petrie; John J V McMurray Journal: Eur Heart J Date: 2018-10-01 Impact factor: 29.983