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Spironolactone Treatment and Clinical Outcomes in Patients With Systolic Dysfunction and Mild Heart Failure Symptoms: A Retrospective Analysis

Accession number;06A0361079

Title;Spironolactone Treatment and Clinical Outcomes in Patients With Systolic Dysfunction and Mild Heart Failure Symptoms: A Retrospective Analysis

Author; BALIGA RAGAVENDRA R. (From The Dep. Of Internal Medicine, Div. Of Cardiovascular Medicine At The Univ. Of Michigan, Ann Arbor, Michigan) RANGANNA PRATHIBA (From The Dep. Of Internal Medicine, Div. Of Cardiovascular Medicine At The Univ. Of Michigan, Ann Arbor, Michigan) PITT BERTRAM (From The Dep. Of Internal Medicine, Div. Of Cardiovascular Medicine At The Univ. Of Michigan, Ann Arbor, Michigan) KOELLING TODD M. (From The Dep. Of Internal Medicine, Div. Of Cardiovascular Medicine At The Univ. Of Michigan, Ann Arbor, Michigan)

Journal Title;J Card Fail

Journal Code:W1342A

ISSN:1071-9164

VOL.12;NO.4;PAGE.250-256(2006)

Figure&Table&Reference;FIG.2, TBL.7, REF.20

Pub. Country;United States

Language;English

Abstract;The effect of spironolactone on clinical outcomes in patients with mild heart failure is unclear. We performed a retrospective analysis of 482 consecutive patients with left ventricular ejection fraction .LEQ.40% and New York Heart Association I-II symptoms. Major cardiac event (MCE) was defined as death, left ventricular assist device implantation, or United Network of Organ Sharing 1 cardiac transplantation. Proportional hazards analysis was used to determine predictors of MCE and to derive an adjusted hazard for spironolactone therapy. Spironolactone was prescribed to 279 (58%) patients and mean follow-up was 1029 days. After controlling for predictors of clinical events, spironolactone treatment was associated with a trend for lower risk of MCE or heart failure rehospitalization (HR, 0.68; 95% CI, 0.43-1.07; P = .095). Exploration of interaction terms between medications revealed that treatment with the combination of spironolactone and thiazide diuretics was associated with lower risk of clinical events (HR, 0.32; 95% CI, 0.12-0.89; P = .029). In subjects with mild heart failure treated with a thiazide diuretic, the use of spironolactone is associated with reduced risk of MCE or heart failure rehospitalization. A randomized controlled trial is necessary to accurately define the clinical effects of spironolactone in patients with mild heart failure. Copyright 2006 Elsevier B.V., Amsterdam.All rights reserved.

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