Abstract 17494: Discharge Use of Spironolactone was Associated with Lower Long-term Mortality in Patients Hospitalized with Systolic Heart Failure
Introduction: Large-scale clinical trial, Randomized Aldactone Evaluation Study (RALES), demonstrated that spironolactone decreased the mortality of heart failure (HF) patients. However, it is unknown whether the use of spironolactone is associated with better long-term outcomes among hospitalized systolic HF patients encounterd in routine clinical practice.
Hypothesis: We thus determined whether spironolactone use at discharge could reduce the mortality and rehospitalization rates by comparing them in patients who did not receive it.
Methods: We analyzed the data from multicenter prospective patient registry, in which the characteristics, treatments, and outcomes were registered in a broad sample of patients hospitalized with worsening HF with an average of 2.2 years of follow-up after discharge.
Results: A total of 946 patients had HF with reduced left ventricular ejection fraction (LVEF; < 40%), among whom spironolactone was prescribed at discharge in 435 patients (46%), but not in 511 patients (54%). The mean age was 66.3±13.7 years and 72.2% were male. Etiology was ischemic in 39.7% and mean LVEF was 27.1±7.3%. During the follow-up, the rates of adverse outcomes were as follows; all-cause death 17.8%, cardiac death 11.8%, rehospitalization due to the worsening HF 33.4%, and all-cause death or rehospitalization 40.0%. The unadjusted rates of cardiac death were significantly lower in patients with spironolactone use [hazard ratio (HR) 0.655, 95% confidence interval (CI) 0.435–0.986, P=0.041]. After adjustment for covariates and propensity score, discharge use of spironolactone was associated with a significant reduction in all-cause death (HR 0.652, 95% CI 0.425–1.000, P=0.050) and cardiac death (HR 0.506, 95% CI 0.294–0.869, P=0.014). However, spironolactone use did not affect the risk of rehospitalization due to worsening HF (HR 0.798, 95% CI 0.592–1.077, P=0.140).
Conclusions: Among “real world” HF patients hospitalized for systolic HF, spironolactone use at the time of discharge was associated with long-term survival benefit. These findings provide further support for the idea that spironolactone is useful for patients with HF and reduced LVEF registered not only in clinical trials but also in usual practice.
- © 2010 by American Heart Association, Inc.