Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms Review article

Abstract

Aim: Mineralocorticoid antagonists improve survival among patients with chronic, severe systolic heart failure and heart failure after myocardial infarction. Aim of the study was evaluation the effects of eplerenone in patients with mild chronic systolic heart failure.

Methods: In this randomized, double-blind trial, there were enrolled 2737 patients with New York Heart Association class II heart failure and an ejection fraction of no more than 35% to receive eplerenone (up to 50 mg daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.

Results: The trial was stopped prematurely after a median follow-up period of 21 months. The primary outcome occurred in 18.3% of patients in the eplerenone group as compared with 25.9% in the placebo group (HR 0.63; P <0.001). A total of 12.5% of patients receiving eplerenone and 15.5% of those receiving placebo died (HR 0.76; P=0.008); 10.8% and 13.5%, respectively, died of cardiovascular causes (HR 0.76; P=0.01). Hospitalizations for heart failure and for any cause were also reduced with eplerenone. A serum potassium level exceeding 5.5 mmol per liter occurred in 11.8% of patients in the eplerenone group and 7.2% of those in the placebo group (P <0.001).

Conclusions: Eplerenone, as compared with placebo, reduced both the risk of death and the risk of hospitalization among patients with systolic heart failure and mild symptoms.