Long-term spironolactone use may improve heart function, but does not improve symptoms, quality of life for heart failure patients

In patients with heart failure with preserved ejection fraction, long-term treatment with spironolactone improved left ventricular diastolic function, but didn’t affect maximal exercise capacity, patient symptoms, or quality of life (QoL), according to a recent study in JAMA.

The study was a multicenter, prospective, randomized, double-blind, placebo-controlled trial conducted between March 2007 and April 2012 at 10 sites in Germany and Austria. It included 422 ambulatory patients older than aged 50 years having at least 1 additional cardiovascular risk factor designed for the understanding factors involved in the development and the progression of diastolic dysfunction and heart failure with preserved ejection fraction. QoL was measured in all patients using a comprehensive questionnaire also containing the SF-36.

Patients were randomly assigned to receive 25 mg of spironolactone once daily or matching placebo with 12 months of follow-up.

“First, QoL is reduced in diastolic dysfunction (DD) which was never before investigated in such a large sample size and well characterized patient cohort,” lead study author Frank Edelmann, MD, of the University of Göttingen, Germany, told Formulary. “Secondly the presence of elevated filling pressures in diastolic dysfunction as a surrogate of heart failure with preserved ejection fraction seem to play a major role regarding this observation. Therefore, we aimed to investigate this association and to better understand the impacting factors such as demographic and neurohumoral activation regarding this issue.”

In conclusion, Dr Edelmann said: “Physical dimensions of QoL are reduced in diastolic dysfunction. Impaired SF-36-PF is only weakly associated with diastolic dysfunction per se but rather seems to be contingent on the presence of elevated filling pressures,” he said. “Biomarkers are more strongly and independently associated with SF-36-PF and may be more adequate surrogate markers of QoL in diastolic dysfunction than echocardiographic measurements.”