WASHINGTON, DC—Among eligible patients with heart failure and reduced ejection fraction (HFrEF), use of spironolactone was associated with improved clinical outcomes, reported Essraa Bayoumi, from the Veterans Affairs Medical Center, Washington, DC, at the ACC.17 Scientific Session.

Previous randomized controlled trials have demonstrated the efficacy of aldosterone antagonists in HFrEF patients but “there is limited evidence of their clinical effectiveness in real-world eligible patients with HFrEF,” Bayoumi stated. A team of researchers sought to examine the clinical efficacy of spironolactone in these patients. 

They searched the Medicare-linked OPTIMIZE-HF registry and identified 6,524 hospitalized patients with heart failure and ejection fraction ≤35%, who had an estimated glomerular filtration (eGFR) ≥30, and were not receiving spironolactone on admission. Of these patients, 829 received a new prescription for the drug upon discharge. 

A cohort of 824 pairs of patients, receiving and not receiving spironolactone, were formed with balanced baseline characteristics. The matched patients had a mean age of 75 years and a mean ejection fraction of 24%. 

The combined outcome of all-cause readmission or all-cause mortality occurred in 95% of patients receiving spironolactone and in 96% of patients not receiving spironolactone (hazard ratio [HR] 0.89, 95% CI: 0.81–0.98). “Spironolactone use had no significant association with heart failure readmission (HR 0.89, 95% CI: 0.78-1.01), but was associated with significant reduction in all-cause readmission (HR 0.88, 95% CI 0.79–0.97),” concluded Bayoumi.