title: Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Mary N
authors.initials: MN
authors.lastname: Walsh
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Westlake Canary
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Ray E
authors.initials: RE
authors.lastname: Hershberger
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D000450:Aldosterone / Q000502:physiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000077545:Eplerenone; D006321:Heart / Q000187:drug effects; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D013148:Spironolactone / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone