title: Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study).
abstract: The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers. We conducted a secondary analysis of the biomarker substudy of the multicenter COACH (Co-ordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) trial involving 534 AHF patients for 30-day mortality and HF rehospitalizations. Spironolactone therapy was initiated and terminated at the discretion of the treating physician; 30-day outcomes were compared between patients who were treated with spironolactone and those who were not. Outcomes with spironolactone therapy were explored based on N-terminal pro-B-type natriuretic peptide, ST2, galectin-3, and creatinine levels. Spironolactone was prescribed to 297 (55.6%) patients at discharge (158 new and 139 continued). There were 19 deaths and 30 HF rehospitalizations among 46 patients by 30 days. Patients discharged on spironolactone had significantly less 30-day event (hazard ratio 0.538, p = 0.039) after adjustment for multiple risk factors. Initiation of spironolactone in patients who were not on spironolactone before admission was associated with a significant reduction in event rate (hazard ratio 0.362, p = 0.027). The survival benefit of spironolactone was more prominent in patient groups with elevations of creatinine, N-terminal pro-B-type natriuretic peptide, ST2, or galectin-3. In conclusion, AHF patients who received spironolactone during hospitalization had significantly fewer 30-day mortality and HF rehospitalizations, especially in high-risk patients.
authors.affiliation: Division of Cardiology, University of California San Diego, San Diego, California. Electronic address: amaisel@ucsd.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.affiliation: Division of Cardiology, University of California San Diego, San Diego, California.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Division of Health, Activity and Care, Department of Social- and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: Division of Cardiology, Emory University, Atlanta, Georgia.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: Division of Cardiology, University of California San Diego, San Diego, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000008:administration & dosage*; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D004232:Diuretics; D013148:Spironolactone