Usefulness of spironolactone in a specialized heart failure clinic.

Journal Article (Journal Article)

Several case series published after the Randomized Aldactone Evaluation Study (RALES) have focused on the adverse effects of spironolactone when prescribed to participants not in a trial and the appropriateness of these prescribing practices; however, there is a paucity of data on potential benefits in patients not in a trial. Therefore, we examined data from a prospective cohort study of 1,037 patients with heart failure seen at the University of Alberta Heart Function Clinic. Median age was 69 years, 66% were men, 75% had systolic dysfunction, and mean ejection fraction was 33%. Only 40% of the 136 patients prescribed spironolactone had New York Heart Association class III or IV symptoms, and <25% fulfilled all of the RALES eligibility criteria. Mean daily dose of spironolactone was 23.9 mg; 25% of patients had spironolactone withdrawn after initiation, mostly due to increases in potassium and/or creatinine (9%), gynecomastia (5%), or dehydration/hyponatremia (6%). Only 1 of our spironolactone-treated patients developed serum potassium >6 mmol/L. Cox's proportional hazards analysis confirmed the association between use of spironolactone and increased survival rate (relative risk 0.09, 95% confidence interval 0.02 to 0.39), even though 78% of our patients did not fulfill the RALES eligibility criteria. Thus, although the complication rate was higher, the benefits of spironolactone seen in RALES extended to participants not in a trial who were treated with similar doses and followed closely in a clinic specializing in heart failure.

Full Text

Duke Authors

Cited Authors

  • Sligl, W; McAlister, FA; Ezekowitz, J; Armstrong, PW

Published Date

  • August 15, 2004

Published In

Volume / Issue

  • 94 / 4

Start / End Page

  • 443 - 447

PubMed ID

  • 15325926

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2004.04.059


  • eng

Conference Location

  • United States