Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction Heart Failure Society of America Guidelines Committee

Javed Butler, Justin A. Ezekowitz, Sean P. Collins, Michael M. Givertz, John R. Teerlink, Mary N. Walsh, Nancy M. Albert, Cheryl A. Westlake Canary, Peter E. Carson, Monica Colvin-Adams, James C. Fang, Adrian F. Hernandez, Ray E. Hershberger, Stuart D. Katz, Joseph G. Rogers, John A. Spertus, William G. Stevenson, Nancy K. Sweitzer, W. H. Wilson Tang, Wendy Gattis StoughRandall C. Starling

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Aldosterone antagonists (or mineralocorticoid receptor antagonists [MRAs]) are guideline-recommended therapy for patients with moderate to severe heart failure (HF) symptoms and reduced left ventricular ejection fraction (LVEF), and in postmyocardial infarction patients with HF. The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) trial evaluated the MRA eplerenone in patients with mild HF symptoms. Eplerenone reduced the risk of the primary endpoint of cardiovascular death or HF hospitalization (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.54-0.74, P <.001) and all-cause mortality (adjusted HR 0.76, 95% CI 0.62-0.93, P <.008) after a median of 21 months. Based on EMPHASIS-HF, an MRA is recommended for patients with New York Heart Association (NYHA) Class II-IV symptoms and reduced LVEF (<35%) on standard therapy (Strength of Evidence A). Patients with NYHA Class II symptoms should have another high-risk feature to be consistent with the EMPHASIS-HF population (age >55 years, QRS duration >130 msec [if LVEF between 31% and 35%], HF hospitalization within 6 months or elevated B-type natriuretic peptide level). Renal function and serum potassium should be closely monitored. Dose selection should consider renal function, baseline potassium, and concomitant drug interactions. The efficacy of eplerenone in patients with mild HF symptoms translates into a unique opportunity to reduce morbidity and mortality earlier in the course of the disease.

Original languageEnglish (US)
Pages (from-to)265-281
Number of pages17
JournalJournal of cardiac failure
Volume18
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Keywords

  • Aldosterone antagonists
  • eplerenone
  • heart failure
  • spironolactone

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Butler, J., Ezekowitz, J. A., Collins, S. P., Givertz, M. M., Teerlink, J. R., Walsh, M. N., Albert, N. M., Westlake Canary, C. A., Carson, P. E., Colvin-Adams, M., Fang, J. C., Hernandez, A. F., Hershberger, R. E., Katz, S. D., Rogers, J. G., Spertus, J. A., Stevenson, W. G., Sweitzer, N. K., Wilson Tang, W. H., ... Starling, R. C. (2012). Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction Heart Failure Society of America Guidelines Committee. Journal of cardiac failure, 18(4), 265-281. https://doi.org/10.1016/j.cardfail.2012.02.005