Does Spironolactone Benefit Patients with HF and Preserved Systolic Function?

Mineralocorticoid-receptor antagonists such as spironolactone reduce risk for adverse events in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). In small studies, these drugs improved diastolic and myocardial function, even in patients with normal LVEF (NEJM JW Cardiol Mar 13 2013).

To test whether spironolactone improves clinical outcomes in HF patients with preserved systolic function, investigators for the international, NIH-sponsored TOPCAT trial randomized 3445 adults (mean age, 69; approximately 50% women) who had a HF hospitalization within the previous year or an elevated natriuretic peptide level within the previous 60 days to receive spironolactone or placebo in addition to their existing trea…