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Aldosterone antagonists ‘should be used routinely in heart failure’

By Lilian Anekwe

Patients with heart failure could benefit from much earlier use of aldosterone agonists, suggest the results of a major randomised controlled trial.

Prescribing eplerenone to patients with mild heart failure achieved large reductions in both the risk of death and the risk of hospitalisation compared with placebo, the trial – published in the latest NEJM - found.

An international team of researchers randomised 2,737 patients in 29 countries – including the UK - with class II systolic heart failure and an ejection fraction of no more than 35%, to receive up to 50mg of eplerenone daily, or placebo, as well as an ACE inhibitor, ARB or beta blocker.

After a median follow-up of 21 months, patients on eplerenone showed a 37% reduction in the primary end point – a composite of death from cardiovascular causes or hospitalisation for heart failure – a 24% reduction in cardiovascular death, and a 42% reduction in hospitalisation for heart failure.

Eplerenone is licensed in the UK as an adjunct in patients with heart failure following a myocardial infarction. But the researchers argued their results mean the benefit also extends to patients with mild disease.

Speaking at the American Heart Association 2010 scientific sessions in Chicago, where the trial was presented this week, Dr Faiez Zannad, a cardiologist at Nancy University in France said: ‘We believe that the robustness of these findings… provides compelling evidence for a change in clinical practice. I would say that all patients with systolic dysfunction are now eligible for an aldosterone antagonist, except for those with contraindications.'

Aldosterone antagonists 'should be used routinely in heart failure'