Navigation Links
Clinicians urged to consider spironolactone in HFPEF despite TOPCAT results
Date:5/18/2014

Athens, 18 May 2014: Clinicians have been urged to consider using spironolactone in their patients with heart failure and preserved ejection fraction (HFPEF) after a post-hoc analysis of the TOPCAT trial showed benefit in patients from the Americas.

The research was presented today at the Heart Failure Congress 2014 in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Professor Bertram Pitt said: "We've had many studies showing that ACE inhibitors, angiotensin receptor blockers, beta blockers and mineralocorticoid receptor blockers reduce mortality and hospitalisations in patients with heart failure and reduced ejection fraction (HFREF). But no studies have found a benefit of these medications in HFPEF patients."

He added: "The results of TOPCAT are complicated. The trial failed to meet its primary endpoint but post-hoc analysis has shown that spironolactone was beneficial in patients from the Americas. I think individual clinicians around the world need to look at the data and decide for themselves. If I was a clinician I would use spironolactone in my patients with HFPEF."

TOPCAT randomised 3445 patients with HFPEF to receive spironolactone, a mineralocorticoid receptor antagonist, at a dose of 15-45mg per day or placebo on top of usual care. Patients were recruited from 270 medical centres in 6 countries. Nearly half of the patients were from Russia and Georgia, and the remainder were from the Americas which included Canada, the US, Argentina and Brazil.

After a mean follow up of 3.3 years, the primary endpoint - which was a composite of reduction in cardiovascular mortality, resuscitated cardiac arrest and hospitalisation for heart failure - was reduced but was not reduced significantly.1 It occurred in 320 of 1722 patients in the spironolactone group (18.6%) and 351 of 1723 patients in the placebo group (20.4%) (hazard ratio [HR]=0.89; 95% confidence interval [CI]=0.77 to 1.04; p=0.14).

One component of the primary endpoint, time to heart failure hospitalisations, was reduced significantly. It occurred in 12.0% patients in the spironolactone group and 14.2% in the placebo group (HR=0.83; 95% CI=0.69 to 0.99; p=0.04).

In patients treated with spironolactone there was an associated increase in serum creatinine and the rate of hyperkalemia doubled. But Professor Pitt said: "These alterations did not have adverse affects. There were no deaths attributable to hyperkalemia and no increase in renal failure."

He continued: "The overall results of the trial were negative in that the primary endpoint was not reduced significantly. But when we examine the results by geographical region they tell a different story."

Post-hoc analysis showed that patients recruited from Russia and Georgia had an extremely low placebo event rate that was not compatible with prior HFPEF studies. In contrast, patients from the Americas had an increased placebo event rate that was compatible with previous studies. In the Americas there was a significant reduction in the primary endpoint, including cardiovascular mortality and hospitalisations for heart failure.

Professor Pitt said: "The low placebo event rate in patients from Russia and Georgia was equal to that of patients with hypertension or another cardiovascular risk factor, not heart failure. We suspect that many of the patients from these countries did not have HFPEF, but had shortness of breath due to obesity or lung disease and were misclassified as heart failure. Whereas patients in the Americas did have HFPEF."

He concluded: "My view is that spironolactone works very well in HFPEF patients and our results were diluted by the inclusion of patients without HFPEF. Clinicians should look at our data and make their own decision about whether to offer spironolactone to their HFPEF patients. I would certainly use it given the lack of other treatments. Provided clinicians monitor potassium and renal function, the results of the TOPCAT trial show that spironolactone can be given safely to patients with HFPEF."

--


'/>"/>
Contact: ESC Press Office
press@escardio.org
33-622-834-576
European Society of Cardiology
Source:Eurekalert

Related medicine news :

1. New study suggests clinicians overlook alcohol problems if patients are not intoxicated
2. Disorders of consciousness: How should clinicians respond to new therapeutic interventions?
3. New tool for clinicians proves effective predictor of lung cancer risk
4. When clinicians and researchers look outside the box
5. Survey of clinicians: User satisfaction with electronic health records has decreased since 2010
6. AMD Global Telemedicine Increases Data Sharing Capabilities for Clinicians and Physicians with AGNES 3.1.0
7. AGA honors distinguished clinicians, researchers and educators with prestigious recognition awards
8. Clinicians often wait for red flags before discussing elderly driving
9. Nineteen Clinicians Receive Advanced Certifications at BenchMark Physical Therapy
10. Astronaut Story Musgrave, MD, to Deliver a Keynote Address at Pri-Med East Conference & Exhibition for Primary Care Clinicians
11. Is clinicians decision making affected by precious baby phenomenon?
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:3/22/2017)... ... ... Schneider Insurance and Financial, a southern Montana firm providing asset protection and financial ... a charity event aimed at raising local support for Zoo Montana. , Zoo Montana ... home to a broad variety of animals from all over the world. Many of ...
(Date:3/22/2017)... ... March 22, 2017 , ... Chris Humphrey Insurance Agency, a North ... professionals throughout the coastal plains region, is initiating a charity event to raise support ... was first diagnosed with leukemia on a Friday evening in September 2014. At the ...
(Date:3/22/2017)... Olathe, KS (PRWEB) , ... March 22, 2017 , ... ... Coach Bill Self still makes time for recruiting – that is, recruiting people to ... their hearts and homes to children who are in foster care due to abuse, ...
(Date:3/22/2017)... ... March 22, 2017 , ... HumanHaus is proud to announce the launch ... broom was great when it was invented, but our customers today are busy, energetic, ... social young couple, the empty nesters and retired that want to travel. ...
(Date:3/22/2017)... ... ... NYC Chiropractor Dr. Steven Shoshany recently helped host a seminar at his ... U.S. and focused on a new protocol for treating pain. Dr. Shoshany is among ... and furthermore the first seminar in the country was hosted at his Integrated Chiropractic ...
Breaking Medicine News(10 mins):
(Date:3/22/2017)...  ImaginAb Inc. today announced the appointment of Martyn Coombs ... , chairman of ImaginAb, said "At ImaginAb we have exciting science ... relevant to our business, particularly in commercializing and making step changes ... we can realize our potential." ... Mr. Coombs is a recognized industry leader in nuclear ...
(Date:3/22/2017)... 2017 Research and Markets has announced ... Market & Clinical Pipeline Insight 2022" drug pipelines to ... ... Pipeline Insight 2022 report gives comprehensive insight on clinical and ... check point inhibitors as main streamline drugs in the immunotherapy ...
(Date:3/22/2017)... LINCOLN, Mass. , March 22, 2017 /PRNewswire/ ... applying mechanistic modeling to drug research and development, ... QSP Day 2017.  QSP Day 2017 is a ... with the quantitative systems pharmacology (QSP) community. The ... mathematical modeling is de-risking and accelerating drug research ...
Breaking Medicine Technology: