Eplerenone improves outcomes for patients with mild systolic heart failure

January 01, 0001

Eplerenone improves outcomes for patients with mild systolic heart failure

Mineralocorticoid antagonists improve survival among patients with chronic, severe systolic heart failure and heart failure after myocardial infarction. These authors from multiple countries evaluated the effects of eplerenone in patients with chronic systolic heart failure and mild symptoms in a randomized, double-blind trial. They randomly assigned 2737 patients with New York Heart Association class II heart failure and an ejection fraction of no more than 35% to receive eplerenone (up to 50 mg daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.

They found: "The trial was stopped prematurely, according to prespecified rules, after a median follow-up period of 21 months. The primary outcome occurred in 18.3% of patients in the eplerenone group as compared with 25.9% in the placebo group (hazard ratio, 0.63). A total of 12.5% of patients receiving eplerenone and 15.5% of those receiving placebo died (hazard ratio, 0.76); 10.8% and 13.5%, respectively, died of cardiovascular causes (hazard ratio, 0.76). Hospitalizations for heart failure and for any cause were also reduced with eplerenone. A serum potassium level exceeding 5.5 mmol per liter occurred in 11.8% of patients in the eplerenone group and 7.2% of those in the placebo group."

The authors concluded: "Eplerenone, as compared with placebo, reduced both the risk of death and the risk of hospitalization among patients with systolic heart failure and mild symptoms."

These are fairly impressive results.

For the full abstract, click here.

N Engl J Med 364:11-21, 6 January 2011
© 2011 to the Massachusetts Medical Society
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. Faiez Zannad, John J.V. McMurray, Henry Krum, et al. Correspondence to Dr. Zannad: [email protected]

Category: K. Circulatory. Keywords: eplerenone, systolic heart failure, hospitalization, death, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 21 January 2011

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