Featured Research

from universities, journals, and other organizations

Long-term use of medication does not improve symptoms for heart failure patients

Date:
February 26, 2013
Source:
American Medical Association (AMA)
Summary:
Among patients with heart failure with preserved ejection fraction, long-term treatment with the medication spironolactone improved left ventricular diastolic function but did not affect maximal exercise capacity, patient symptoms, or quality of life, according to a new study.

Among patients with heart failure with preserved ejection fraction, long-term treatment with the medication spironolactone improved left ventricular diastolic function but did not affect maximal exercise capacity, patient symptoms, or quality of life, according to a study appearing in the February 27 issue of JAMA.

"Heart failure (HF) with preserved ejection fraction [EF; the percentage of blood that is pumped out of a filled ventricle as a result of a heartbeat is 50 percent or greater] accounts for more than 50 percent of the total HF population," according to background information in the article. There is not an established therapy for this condition, and aldosterone (a hormone) stimulation may contribute to its progression.

Frank Edelmann, M.D., of the University of Gottingen, Germany, and colleagues conducted a study to examine the long-term effects of spironolactone, an aldosterone receptor blocker, on diastolic function and exercise capacity in patients with HF with preserved EF. The Aldo-DHF trial, a randomized, placebo-controlled trial, was conducted between March 2007 and April 2012 at 10 sites in Germany and Austria. The study included 422 patients (average age, 67 years) with chronic New York Heart Association class II or III heart failure, preserved left ventricular ejection fraction of 50 percent or greater, and evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow-up. The primary outcomes measured were changes in diastolic function (E/e') on echocardiography and maximal exercise capacity (peak VO2) on cardiopulmonary exercise testing.

The researchers found that spironolactone improved some measures (left ventricular end-diastolic filling, left ventricular remodeling, and neurohumoral activation). Maximal exercise capacity did not significantly change with spironolactone vs. placebo, and spironolactone did not improve heart failure symptoms or quality of life and slightly reduced 6-minute walking distance. "Spironolactone also modestly increased serum potassium levels and decreased estimated glomerular filtration rate without affecting hospitalizations."

The authors conclude that the "lack of accepted minimal clinically important differences in E/e' or peak VO2 in HF with preserved EF warrants additional prospective, randomized, adequately powered studies to further evaluate the effect of improving diastolic function on symptomatic, functional, and clinical end points."

Editorial: Defining Diastolic Heart Failure and Identifying Effective Therapies

"Ultimately, Aldo-DHF trial provides valuable new information but is not particularly reassuring in terms of either the efficacy or safety of mineralocorticoid antagonists (MRAs) for patients with heart failure with preserved ejection fraction (HFpEF),"writes John G. F. Cleland, M.D., Ph.D., F.R.C.P., and Pierpaolo Pellicori, M.D., of the University of Hull, Kingston-upon-Hull, England, in an accompanying editorial.

"In the meantime, MRAs appear useful for managing congestion and preventing diuretic-induced hypokalemia [abnormally low level of potassium in the circulating blood] with the attendant risk of sudden arrhythmic death. It is likely that these benefits are independent of cardiac phenotype but might be more prominent in those with impaired aldosterone degradation due to hepatic congestion. Whether MRAs exert important benefits for patients with HFpEF through other mechanisms such as reducing fibrosis, inflammation, and adrenergic activity may take longer to unravel."


Story Source:

The above story is based on materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length.


Journal Reference:

  1. Frank Edelmann et al. Effect of Spironolactone on Diastolic Function and Exercise Capacity in Patients With Heart Failure With Preserved Ejection FractionThe Aldo-DHF Randomized Controlled Trial. JAMA, 2013 DOI: 10.1001/jama.2013.905

Cite This Page:

American Medical Association (AMA). "Long-term use of medication does not improve symptoms for heart failure patients." ScienceDaily. ScienceDaily, 26 February 2013. <www.sciencedaily.com/releases/2013/02/130226162725.htm>.
American Medical Association (AMA). (2013, February 26). Long-term use of medication does not improve symptoms for heart failure patients. ScienceDaily. Retrieved October 19, 2014 from www.sciencedaily.com/releases/2013/02/130226162725.htm
American Medical Association (AMA). "Long-term use of medication does not improve symptoms for heart failure patients." ScienceDaily. www.sciencedaily.com/releases/2013/02/130226162725.htm (accessed October 19, 2014).

Share This



More Health & Medicine News

Sunday, October 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Microneedle Patch Promises Painless Pricks

Microneedle Patch Promises Painless Pricks

Reuters - Innovations Video Online (Oct. 18, 2014) Researchers at The National University of Singapore have invented a new microneedle patch that could offer a faster and less painful delivery of drugs such as insulin and painkillers. Video provided by Reuters
Powered by NewsLook.com
Raw: Nurse Nina Pham Arrives in Maryland

Raw: Nurse Nina Pham Arrives in Maryland

AP (Oct. 17, 2014) The first nurse to be diagnosed with Ebola at a Dallas hospital walked down the stairs of an executive jet into an ambulance at an airport in Frederick, Maryland, on Thursday. Pham will be treated at the National Institutes of Health. (Oct. 16) Video provided by AP
Powered by NewsLook.com
Raw: Cruise Ship Returns to US Over Ebola Fears

Raw: Cruise Ship Returns to US Over Ebola Fears

AP (Oct. 17, 2014) A Caribbean cruise ship carrying a Dallas health care worker who is being monitored for signs of the Ebola virus is heading back to Texas, US, after being refused permission to dock in Cozumel, Mexico. (Oct. 17) Video provided by AP
Powered by NewsLook.com
Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

AFP (Oct. 17, 2014) All four suspected Ebola cases admitted to hospitals in Spain on Thursday have tested negative for the deadly virus in a first round of tests, the government said Friday. Duration: 00:55 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins