18 Jul Does Spironolactone Work In Acute Heart Failure?
MedicalResearch.com Interview with:
Javed Butler, MD, PhD
Chief of the Cardiology Division
Dr. Vincent Yang, Simons Chair in Internal Medicine
Stony Brook University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. We therefore studies high dose spironolactone in patients with AHF. Unfortunately all of our primary and secondary endpoints were not different between spironolactone and placebo arms.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: High dose spironolactone should not be used routinely in the short term management of acute heart failure, however chronic use of lower doses in patient with heart failure with reduced ejection fraction is still recommended.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The biologic rationale for the study still is sound, however, future research should target a sicker population with worse renal function and the intervention should likely last for more than 4 days.
Disclosures: Research support from the NIH, European Union, and Patient Centered Outcomes Research Institute, and consultant to Amgen, Astra-Zeneca, Bayer, Boehringer Ingelheim, BMS, CVRx, Janssen, Medtronic, Novartis, Relypsa, ZS Pharma
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Butler J, Anstrom KJ, Felker GM, Givertz MM, Kalogeropoulos AP, Konstam MA, Mann DL, Margulies KB, McNulty SE, Mentz RJ, Redfield MM, Tang WHW, Whellan DJ, Shah M, Desvigne-Nickens P, Hernandez AF, Braunwald E, for the National Heart Lung and Blood Institute Heart Failure Clinical Research Network. Efficacy and Safety of Spironolactone in Acute Heart FailureThe ATHENA-HF Randomized Clinical Trial. JAMA Cardiol. Published online July 12, 2017. doi:10.1001/jamacardio.2017.2198
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