title: Spironolactone in patients with heart failure and preserved ejection fraction.
abstract: OBJECTIVE
  Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF.
  
  
  METHODS
  We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis.
  
  
  RESULTS
  We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001).
  
  
  CONCLUSIONS
  For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia.
authors: Servicio de Medicina Interna, Complejo Asistencia de Ávila, Ávila, España. Electronic address: crislisis@hotmail.com.
authors: C
authors: C
authors: Sánchez-Sánchez
authors: Servicio de Medicina Interna, Complejo Asistencia de Ávila, Ávila, España.
authors: H F
authors: HF
authors: Mendoza-Ruiz de Zuazu
authors: Servicio de Medicina Interna, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
authors: F
authors: F
authors: Formiga
authors: Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Madrid, España.
authors: L
authors: L
authors: Manzano
authors: Servicio de Medicina Interna, Hospital de ĹHospitalet-Consorci Sanitari Integral, ĹHospitalet de Llobregat, Barcelona, España.
authors: L M
authors: LM
authors: Ceresuela
authors: Servicio de Medicina Interna, Complejo Hospitalario de Soria, Soria, España.
authors: M
authors: M
authors: Carrera-Izquierdo
authors: Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors: Á
authors: Á
authors: González Franco
authors: Unidad de Estancia Corta, Departamento de Medicina UAB, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
authors: F
authors: F
authors: Epelde-Gonzalo
authors: Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España.
authors: J M
authors: JM
authors: Cerqueiro-González
authors: Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, España.
authors: M
authors: M
authors: Montero-Pérez-Barquero
keywords: Aldosterone antagonists; Antagonistas de la aldosterona; Diastolic heart failure; Espironolactona; Insuficiencia cardiaca diastólica; Prognosis; Pronóstico; Spironolactone