| Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction heart failure society of america guidelines committee. | |
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MedLine Citation:
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PMID: 22464767 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Aldosterone antagonists (or mineralocorticoid receptor antagonists [MRAs]) are guideline-recommended therapy for patients with moderate to severe heart failure (HF) symptoms and reduced left ventricular ejection fraction (LVEF), and in postmyocardial infarction patients with HF. The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) trial evaluated the MRA eplerenone in patients with mild HF symptoms. Eplerenone reduced the risk of the primary endpoint of cardiovascular death or HF hospitalization (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.54-0.74, P < .001) and all-cause mortality (adjusted HR 0.76, 95% CI 0.62-0.93, P < .008) after a median of 21 months. Based on EMPHASIS-HF, an MRA is recommended for patients with New York Heart Association (NYHA) Class II-IV symptoms and reduced LVEF (<35%) on standard therapy (Strength of Evidence A). Patients with NYHA Class II symptoms should have another high-risk feature to be consistent with the EMPHASIS-HF population (age >55 years, QRS duration >130 msec [if LVEF between 31% and 35%], HF hospitalization within 6 months or elevated B-type natriuretic peptide level). Renal function and serum potassium should be closely monitored. Dose selection should consider renal function, baseline potassium, and concomitant drug interactions. The efficacy of eplerenone in patients with mild HF symptoms translates into a unique opportunity to reduce morbidity and mortality earlier in the course of the disease. |
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Authors:
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Javed Butler; Justin A Ezekowitz; Sean P Collins; Michael M Givertz; John R Teerlink; Mary N Walsh; Nancy M Albert; Cheryl A Westlake Canary; Peter E Carson; Monica Colvin-Adams; James C Fang; Adrian F Hernandez; Ray E Hershberger; Stuart D Katz; Joseph G Rogers; John A Spertus; William G Stevenson; Nancy K Sweitzer; W H Wilson Tang; Wendy Gattis Stough; Randall C Starling |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiac failure Volume: 18 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2012 Apr |
Date Detail:
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Created Date: 2012-04-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 265-81 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Medicine, Division of Cardiology, Emory University, Atlanta, GA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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