A complex syndrome that sometimes can be difficult to manage because of a dearth of evidence-based therapies, HFpEF is increasing in prevalence and diagnosed in millions worldwide, according to the report from researchers from the Massachusetts Veterans Epidemiology and Research Information Center, who also conducted the studies in conjunction with Harvard, Boston, and Brown Universities.
Based on previous research that suggested a benefit, the study team sought to determine the effectiveness of spironolactone in reducing death and hospitalization outcomes for patients with HFpEF in a real-world setting. The results were published in the Journal of the American Heart Association.
Electronic health records from the Department of Veterans’ Affairs healthcare system between 2002 and 2012 were used to find patients with HFpEF who were followed longitudinally through 2014 using a validated algorithm. The researchers identified 2,690 spironolactone users and 49,191 nonusers among an HFpEF cohort that was 96% men, 85% white, and with a median age of 74 years. The patients were followed for a median of 2.9 (interquartile range [IQR], 1.5-2.4) and 3.3 (IQR, 1.6-5.9) years, respectively.
The study team observed crude rates of 10.3 versus 13.5 deaths and 394.0 versus 485.9 days hospitalized per 100 person-years for spironolactone users compared with nonusers, respectively. “After multivariable adjustment, there was a 21% reduction (95% CI, 13-29; P <.0001) in rate of all-cause death among spironolactone users compared with nonusers and no statistically significant difference in days hospitalized for all causes or heart failure,” the authors pointed out, adding, “In a real-world national cohort of patients with HFpEF, spironolactone use reduced all-cause death and demonstrated a favorable trend in reducing the burden of hospitalizations.”
The researchers recommended that mineralocorticoid antagonism should be strongly considered in patients with HFpEF. The researchers suggested that ongoing clinical trials will further elucidate the benefits of spironolactone in HFpEF.
Background information in the article described how HFpEF makes up about one-half of the 6.2 million prevalent HF cases in the United States. “HFpEF is associated with poor quality of life, high morbidity and mortality rates, and high health care usage,” the authors explained. “The prevalence of HFpEF has been increasing, likely due to improved clinical recognition and increasing life expectancy among the aging population The HFpEF epidemic is increasing at rates faster than other types of HF.”
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