Skip to main content
Journal cover image

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

Publication ,  Journal Article
Butler, J; Ezekowitz, JA; Collins, SP; Givertz, MM; Teerlink, JR; Walsh, MN; Albert, NM; Westlake Canary, CA; Carson, PE; Colvin-Adams, M ...
Published in: J Card Fail
April 2012

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

April 2012

Volume

18

Issue

4

Start / End Page

265 / 281

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Spironolactone
  • Randomized Controlled Trials as Topic
  • Myocardial Infarction
  • Mineralocorticoid Receptor Antagonists
  • Kidney
  • Humans
  • Hospitalization
  • Heart Failure
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Butler, J., Ezekowitz, J. A., Collins, S. P., Givertz, M. M., Teerlink, J. R., Walsh, M. N., … 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. J Card Fail, 18(4), 265–281. https://doi.org/10.1016/j.cardfail.2012.02.005
Butler, Javed, Justin A. Ezekowitz, Sean P. Collins, Michael M. Givertz, John R. Teerlink, Mary N. Walsh, Nancy M. Albert, et al. “Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee.J Card Fail 18, no. 4 (April 2012): 265–81. https://doi.org/10.1016/j.cardfail.2012.02.005.
Butler J, Ezekowitz JA, Collins SP, Givertz MM, Teerlink JR, Walsh MN, et al. Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee. J Card Fail. 2012 Apr;18(4):265–81.
Butler, Javed, et al. “Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee.J Card Fail, vol. 18, no. 4, Apr. 2012, pp. 265–81. Pubmed, doi:10.1016/j.cardfail.2012.02.005.
Butler J, Ezekowitz JA, Collins SP, Givertz MM, Teerlink JR, Walsh MN, Albert NM, Westlake Canary CA, Carson PE, Colvin-Adams M, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Rogers JG, Spertus JA, Stevenson WG, Sweitzer NK, Tang WHW, Stough WG, Starling RC. Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee. J Card Fail. 2012 Apr;18(4):265–281.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

April 2012

Volume

18

Issue

4

Start / End Page

265 / 281

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Spironolactone
  • Randomized Controlled Trials as Topic
  • Myocardial Infarction
  • Mineralocorticoid Receptor Antagonists
  • Kidney
  • Humans
  • Hospitalization
  • Heart Failure