Featured Research

from universities, journals, and other organizations

Spironolactone reduces heart failure hospitalizations, but not mortality, study says

Date:
November 18, 2013
Source:
Brigham and Women's Hospital
Summary:
A late-breaking clinical trial, known as the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial, demonstrates that spironolactone did not reduce the primary outcome of cardiovascular death, heart failure hospitalization, nor surviving a cardiac arrest in patients with heart failure and preserved ejection fraction. However, spironolactone did reduce the major burden faced by these patients -- the risk of repeated hospitalizations for heart failure.

A late-breaking clinical trial, known as the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, to be presented at the American Heart Association (AHA) Scientific Sessions, November 18, 2013, demonstrates that spironolactone did not reduce the primary outcome of cardiovascular death, heart failure hospitalization, nor surviving a cardiac arrest in patients with heart failure and preserved ejection fraction (pump function). However, spironolactone did reduce the major burden faced by these patients-the risk of repeated hospitalizations for heart failure.

Related Articles


The TOPCAT trial is the first randomized, double-blind trial to assess the effect of spironolactone on clinical outcomes in these patients with heart failure and preserved ejection fraction.

The trial enrolled 3,445 participants from 270 medical centers in six countries. Participants were randomly assigned to receive either spironolactone (target dose of 30 milligrams/day) or matching placebo, and were followed for an average of nearly 3.5 years. Moreover, participants were also treated for other co-existing conditions (e.g., diabetes, high blood pressure, etc.).

According to the researchers, patients randomized to spironolactone were less likely to be hospitalized for heart failure compared to those on placebo. At the end of the study, 206 out of 1722 patients on spironolactone (12 percent) had been hospitalized for heart failure, compared to 245 of 1723 patients (14 percent) given placebo. There were no statistically significant differences between the groups in deaths or hospitalizations from any cause.

The TOPCAT trial also presented the opportunity to study cardiac structure and function in this population through an echocardiography sub-study in 935 patients, which demonstrated a high prevalence of abnormal cardiac structure in these patients. These results will be published simultaneously with the TOPCAT AHA presentation in the AHA journal, Circulation: Heart Failure.

The TOPCAT trial was led by a clinical research team at Brigham and Women's Hospital (BWH) under the direction of Marc A. Pfeffer, MD, PhD, BWH Division of Cardiovascular Medicine, Department of Medicine, in collaboration with the New England Research Institutes, directed by Sonja McKinlay, PhD. The rationale for using spironolactone-an inexpensive, generic, medication-stems from the pioneering research of Bertram Pitt, MD, University of Michigan School of Medicine, who showed the benefit of this class of drugs in patients with heart failure and reduced ejection fraction, and who also served as chair of the TOPCAT Steering Committee.

"At present, therapy for this large proportion of patients with heart failure is empiric, and there remains a huge unmet need," said Scott Solomon, MD, director of BWH Noninvasive Cardiology, who also led the core echocardiography lab for the study.

"While these patients also suffer heart attacks and strokes, hospitalizations for heart failure represent their predominant problem, which is also a major burden to society," said Eldrin Lewis, MD, advanced heart failure specialist, BWH Division of Cardiovascular Medicine, Department of Medicine, who chaired the TOPCAT Clinical Endpoints Committee.

"When treating our patients, clinicians are always balancing risks and benefits," said Akshay S. Desai, MD, MPH, advanced heart failure specialist, BWH Division of Cardiovascular Medicine, Department of Medicine. "The results of TOPCAT will help inform clinicians as they make treatment decisions for this understudied population," Added Desai, "If clinicians choose to use this therapy, they must be vigilant about monitoring for serum markers of kidney and electrolyte disorders which can be exacerbated by spironolactone."


Story Source:

The above story is based on materials provided by Brigham and Women's Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. Amil M. Shah, Sanjiv J. Shah, Inder S. Anand, Nancy K. Sweitzer, Eileen O'meara, John F. Heitner, George Sopko, Guichu Li, Susan F. Assmann, Sonja M. Mckinlay, Bertram Pitt, Marc A. Pfeffer, and Scott D. Solomon. Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction: Baseline Findings From the Echocardiographic Study of the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial. Circulation: Heart Failure, November 2013

Cite This Page:

Brigham and Women's Hospital. "Spironolactone reduces heart failure hospitalizations, but not mortality, study says." ScienceDaily. ScienceDaily, 18 November 2013. <www.sciencedaily.com/releases/2013/11/131118132925.htm>.
Brigham and Women's Hospital. (2013, November 18). Spironolactone reduces heart failure hospitalizations, but not mortality, study says. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2013/11/131118132925.htm
Brigham and Women's Hospital. "Spironolactone reduces heart failure hospitalizations, but not mortality, study says." ScienceDaily. www.sciencedaily.com/releases/2013/11/131118132925.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com
Flu Outbreak Closing Schools in Ohio

Flu Outbreak Closing Schools in Ohio

AP (Dec. 17, 2014) A wave of flu illnesses has forced some Ohio schools to shut down over the past week. State officials confirmed one pediatric flu-related death, a 15-year-old girl in southern Ohio. (Dec. 17) Video provided by AP
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