TOPCAT Revisited: Another Look at Spironolactone for Heart Failure

A reexamination of results by geographic region uncovers differences in patients' self-reports, with possible implications for treatment and trial conduct.

In the randomized, placebo-controlled TOPCAT study of spironolactone in patients with heart failure (HF) and preserved left ventricular ejection fraction, spironolactone showed no benefit for the primary outcome of cardiovascular death, HF hospitalization, and cardiac arrest (NEJM JW Cardiol May 2014 and N Engl J Med 2014; 370:1383). With a study population drawn from the Western Hemisphere, Russia, and Georgia, post hoc analysis identified geographic differences in patient profiles, event rates, and biochemical responses to therapy. To further understand this geographic variation, the TOPCAT investigators analyzed blood samples in 206 North American patients and 160 Russian patients who had 1-year samples placed in a biorepository.

Among pa…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)