Eplerenone can improve outcomes in mild CHF
Use of eplerenone for patients with mildly symptomatic congestive heart failure can reduce their risk of cardiovascular death and first admission to hospital for heart failure, say the authors of the EMPHASIS-HF study published in the New England Journal of Medicine (online 14 November 2010).
The study included 2,737 patients with New York Heart Association class II heart failure (ie, patients with mild symptoms) and a left-ventricular ejection fraction of 35% or less. Patients were randomised to receive eplerenone (up to 50mg daily) or placebo.
The primary outcome — a composite of cardiovascular death and first hospital admission for heart failure — occurred in 18.3% of patients taking eplerenone compared with 25.9% of patients taking placebo (hazard ratio 0.63; 95% confidence interval 0.54–0.74; P<0.001).
Helen Williams, consultant pharmacist for cardiovascular disease in South London, commented: “Before this study, data from the RALES study supported the use of spironolactone in severe chronic heart failure, namely NYHA class IV or NYHA class III with a recent class IV exacerbation [NEJM 1999;341:709]. The EPHESUS data supported the use of eplerenone in post-myocardial infarction heart failure [NEJM 2003;348:1309].”
She explained that EMPHASIS-HF was the first study to investigate the use of an aldosterone antagonist in mild-to-moderate heart failure. In this group of patients, treatment with eplerenone led to a 3% absolute reduction in the risk of death (P=0.008) and a 5.9% absolute reduction in the risk of hospital admission (P<0.001), compared with placebo.
Therapy was generally well tolerated, although treatment with eplerenone was associated with an increased risk of hyperkalaemia.
“EMPHASIS demonstrates that aldosterone antagonists can significantly improve outcomes in all patients with symptomatic chronic heart failure,” Ms Williams said. “This study will no doubt lead to debate as to whether the same outcome could be achieved using spironolactone, at much lower cost.”
Citation: Clinical Pharmacist URI: 11048887
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