Spironolactone in Patients With Heart Failure, Preserved Ejection Fraction, and Worsening Renal Function

Treatment of heart failure with preserved ejection fraction (HFpEF) spironolactone is associated lower risk hospitalization (HFH) but increased worsening renal function (WRF). The prognostic implications spironolactone-associated WRF in HFpEF patients are not well understood. purpose this study was to investigate the association between WRF, treatment, and clinical outcomes HFpEF. In 1,767 randomized or placebo TOPCAT (Treatment Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial)-Americas study, we examined incidence (doubling serum creatinine) by treatment assignment. Associations incident subsequent for primary endpoint cardiovascular (CV) death, HFH, aborted cardiac arrest key secondary outcomes, including CV all-cause mortality according assignment, were time-updated Cox proportional hazards models interaction term. developed 260 (14.7%) higher rates those assigned compared (17.8% vs. 11.6%; odds ratio: 1.66; 95% confidence interval: 1.27 2.17; p < 0.001). Regardless (hazard 2.04; 1.52 2.72; 0.001) after multivariable adjustment. Although there no statistical assignment regarding (interaction = 0.11), death 0.003) placebo-associated WRF. Among enrolled TOPCAT-Americas, placebo. Rates both without