Associations Between Aldosterone Antagonist Therapy and Risks of Mortality and Readmission Among Patients With Heart Failure and Reduced Ejection Fraction

URING THE PAST 30 YEARS, large randomized trials have established the efficacy of multiple therapies for reducing mortality among patients with heart failure and reduced ejection fraction. 1Among the most efficacious therapies for heart failure are the aldosterone antagonists spironolactone and eplerenone.In 2 landmark trials, these agents reduced mortality by 24% to 30% and readmission for heart failure by nearly 40%. 2,3Despite these findings and subsequent class I guideline recommendations, the use of aldosterone antagonist therapy remains lower than expected. 1,4,5low and varied adoption of aldosterone antagonists in clinical practice may be due, in part, to uncertainty about their effectiveness and safety outside clinical trials. 6This uncertainty is especially relevant for patients at high risk See also pp