PMID- 23386667
OWN - NLM
STAT- MEDLINE
DCOM- 20130509
LR  - 20131121
IS  - 1941-3297 (Electronic)
IS  - 1941-3289 (Linking)
VI  - 6
IP  - 2
DP  - 2013 Mar
TI  - Association of spironolactone use with all-cause mortality in heart failure: a 
      propensity scored cohort study.
PG  - 174-83
LID - 10.1161/CIRCHEARTFAILURE.112.000115 [doi]
AB  - BACKGROUND: In 3 randomized controlled trials in heart failure (HF), 
      mineralocorticoid receptor antagonists reduced mortality. The net benefit from 
      randomized controlled trials may not be generalizable, and eplerenone was, but 
      spironolactone was not, studied in mild HF. We tested the hypothesis that 
      spironolactone is associated with reduced mortality also in a broad unselected 
      contemporary population with HF and reduced ejection fraction, in particular New 
      York Heart Association (NYHA) I-II. METHODS AND RESULTS: We prospectively studied 
      18 852 patients (age 71+/-12 years; 28% women) with NYHA I-IV and ejection fraction 
      <40% who were registered in the Swedish Heart Failure Registry between 2000 and 
      2012 and who were (n=6551) or were not (n=12 301) treated with spironolactone. We 
      derived propensity scores for spironolactone treatment based on 41 covariates. We 
      assessed survival by Cox regression with adjustment for propensity scores and 
      with matching based on propensity score. We performed sensitivity and residual 
      confounding analyses and analyzed the NYHA I-II and III-IV subgroups separately. 
      One-year survival was 83% versus 84% in treated versus untreated patients (log 
      rank P<0.001). After adjustment for propensity scores, the hazard ratio for 
      spironolactone was 1.05 (95% confidence interval, 1.00-1.11; P=0.054). 
      Spironolactone interacted with NYHA (P<0.001). In the NYHA I-II subgroup, after 
      adjustment for propensity scores, the hazard ratio for spironolactone was 1.11 
      (95% confidence interval, 1.02-1.21; P=0.019). CONCLUSIONS: In an unselected 
      contemporary population of HF with reduced ejection fraction, spironolactone was 
      not associated with reduced mortality. The net benefits of spironolactone may be 
      lower outside the clinical trial setting and in milder HF.
FAU - Lund, Lars H
AU  - Lund LH
AD  - Department of Medicine, Karolinska Institutet, Stockholm, Sweden. mail 
      lars.lund@alumni.duke.edu
FAU - Svennblad, Bodil
AU  - Svennblad B
FAU - Melhus, Hakan
AU  - Melhus H
FAU - Hallberg, Par
AU  - Hallberg P
FAU - Dahlstrom, Ulf
AU  - Dahlstrom U
FAU - Edner, Magnus
AU  - Edner M
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130205
PL  - United States
TA  - Circ Heart Fail
JT  - Circulation. Heart failure
JID - 101479941
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 27O7W4T232 (Spironolactone)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Heart Failure/*drug therapy/mortality/physiopathology
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Mineralocorticoid Receptor Antagonists/*therapeutic use
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Registries
MH  - Severity of Illness Index
MH  - Spironolactone/*therapeutic use
MH  - Stroke Volume/drug effects
MH  - Sweden/epidemiology
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left/drug effects
EDAT- 2013/02/07 06:00
MHDA- 2013/05/10 06:00
CRDT- 2013/02/07 06:00
PHST- 2013/02/07 06:00 [entrez]
PHST- 2013/02/07 06:00 [pubmed]
PHST- 2013/05/10 06:00 [medline]
AID - CIRCHEARTFAILURE.112.000115 [pii]
AID - 10.1161/CIRCHEARTFAILURE.112.000115 [doi]
PST - ppublish
SO  - Circ Heart Fail. 2013 Mar;6(2):174-83. doi: 10.1161/CIRCHEARTFAILURE.112.000115. 
      Epub 2013 Feb 5.