Effect of Spironolactone on 30-Day Death and Heart Failure Rehospitalization (from the COACH Study)
2014 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 114, no 5, 737-742 p.Article in journal (Refereed) Published
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.
Place, publisher, year, edition, pages
Elsevier , 2014. Vol. 114, no 5, 737-742 p.
IdentifiersURN: urn:nbn:se:liu:diva-111271DOI: 10.1016/j.amjcard.2014.05.062ISI: 000341333600013PubMedID: 25129066OAI: oai:DiVA.org:liu-111271DiVA: diva2:755556
Funding Agencies|Netherlands Heart Foundation [2000Z003]; Roche Diagnostics Nederland BV, Venlo, The Netherlands (NT-proBNP)2014-10-142014-10-142016-06-05