| Appropriateness and complications of the use of spironolactone in patients treated in a heart failure clinic. | |
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MedLine Citation:
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PMID: 21767763 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVES: The widespread use of spironolactone in patients with congestive heart failure (CHF) has resulted in side effects and complications. We analyzed a cohort of patients treated by a dedicated CHF team, in order to examine the tolerability and safety of spironolactone in clinical practice. METHODS: We retrospectively evaluated data on 157 patients who were followed by the Heart Failure clinic of whom 100 patients on maximal treatment (all on β blockers, 99% on ACE inhibitors) received spironolactone. The complications following spironolactone use were defined as: hyperkalemia with serum K 5.2mEq/l; creatinine 2.0mg/dl; hyponatremia with serum Na 135mEq/l, hypotension and side effects such as gynecomastia and abdominal pain. RESULTS: At 1year follow-up 6 patients developed hyperkalemia (range 5.3-5.9), 4 of them had K >5.5mEq/l. Two patients developed hyponatremia. Six patients stopped spironolactone for: 1-gynecomastia, 2-worsening renal failure and hyperkalemia, 2-hyperkalemia (5.9mEq/l) and 1 for bradycardia. There was an increase in mean creatinine level at 1year (1.12±0.35 vs. 1.21±0.38mg/dl, p=0.02), however, no significant changes were found in GFR (99.9±33.5 vs. 65.7±27.7mlmin(-1)1.73m(-2), p=ns) and potassium (4.5±0.4 vs. 4.6±0.5mEq/l, p=ns). We found improvement of GFR by >10% in 19 patients and worsening by >10% in 38 patients. No patient was hospitalized or required urgent treatment for spironolactone-related side effects. CONCLUSIONS: In patients with CHF on optimal therapy with ACE inhibitors and β blockers appropriate spironolactone use and close follow-up by a dedicated HF team can minimize the risk for adverse events and complications. |
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Authors:
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Sorel Goland; Vladimir Naugolny; Zila Korbut; Izabella Rozen; Abraham Caspi; Steven Malnick |
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Publication Detail:
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Type: Journal Article Date: 2011-05-31 |
Journal Detail:
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Title: European journal of internal medicine Volume: 22 ISSN: 1879-0828 ISO Abbreviation: Eur. J. Intern. Med. Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-07-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9003220 Medline TA: Eur J Intern Med Country: Netherlands |
Other Details:
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Languages: eng Pagination: 424-7 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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