Spironolactone After Heart Failure: Assessing 30-Day Outcomes
the MPR take:
Published in the American Journal of Cardiology, research indicates that spironolactone may reduce rehospitalizations and 30-day mortality in patients with acute heart failure (AHF). 534 AHF patients were assessed based on initiation and termination of spironolactone therapy (as determined by their physician) and 30-day outcomes stratified by biomarkers N-terminal pro–B-type natriuretic peptide, ST2, galectin-3, and creatinine levels. Patients discharged on spironolactone had significantly fewer 30-day events, while initiation of spironolactone in patients who were not taking the drug prior to admission was linked to a significant reduction in event rates. Patient groups with elevations of creatinine, N-terminal pro–B-type natriuretic peptide, ST2, or galectin-3 had greater survival benefits seen with spironolactone therapy. Particularly for high-risk patients not taking spironolactone prior to admission for AHF, the medication could significantly reduce the risk of cardiac events and rehospitalizations. Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. It acts both as a diuretic and as an antihypertensive drug by this mechanism.
The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers.