How Is Spironolactone Being Used for Heart Failure in Practice?

In line with data from the RALES randomized, placebo-controlled trial (N Engl J Med 1999; 341:709), guidelines recommend the aldosterone antagonist spironolactone for patients with severe heart failure (HF) who have left-ventricular systolic dysfunction (LVSD), recent or current symptoms at rest despite other appropriate medical therapy, a serum potassium level <5.0 mmol/L, and a pretreatment serum creatinine level <2.5 mg/dL. However, concerns about hyperkalemia due to inappropriate use of spironolactone (or inappropriate monitoring of its use) have surfaced recently (Journal Watch Cardiology Sep 17 2004).

Using the National Heart Care Project database, these researchers reviewed spironolactone prescriptions at hospital discharge among Medi…