High-Dose Spironolactone When Patients With Acute Decompensated Heart Failure Are Resistant to Loop Diuretics: A Pilot Study
Authors: Shweta Bansal, Kristina Munoz, Sonja Brune, Steven Bailey, Anand Prasad, Chakradhar Velagapudi
Journal: Annals of Internal Medicine (2019)

Letters17 September 2019High-Dose Spironolactone When Patients With Acute Decompensated Heart Failure Are Resistant to Loop Diuretics: A Pilot StudyShweta Bansal, MD, Kristina Munoz, BS, Sonja Brune, MSN, Steven Bailey, MD, Anand Prasad, MD, and Chakradhar Velagapudi, PhDShweta Bansal, MDUniversity of Texas Health at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas (S.B., C.V.), Kristina Munoz, BSCentral Michigan University College of Medicine, Saginaw, Michigan (K.M.), Sonja Brune, MSNUniversity of Texas Health at San Antonio, San Antonio, Texas (S.B., S.B., A.P.), Steven Bailey, MDUniversity of Texas Health at San Antonio, San Antonio, Texas (S.B., S.B., A.P.), Anand Prasad, MDUniversity of Texas Health at San Antonio, San Antonio, Texas (S.B., S.B., A.P.), and Chakradhar Velagapudi, PhDUniversity of Texas Health at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas (S.B., C.V.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3285 Annals Author Insight Video - Shweta Bansal, MD In this video, Shweta Bansal, MD, offers additional insight into the article, "High-Dose Spironolactone When Patients With Acute Decompensated Heart Failure Are Resistant to Loop Diuretics: A Pilot Study." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Resistance to loop diuretics occurs frequently in patients with acute decompensated heart failure (1), and secondary hyperaldosteronism plays a major role (2). Aldosterone antagonists are a standard of care in heart failure but are commonly used at low, nonnatriuretic doses to avoid hyperkalemia (3, 4).Objective: To examine whether the addition of high-dose spironolactone could be safe and effective in selected patients with acute decompensated heart failure.Methods: We did a prospective, single-center, nonrandomized trial with informed consent, institutional review board approval, and prior registration (ClinicalTrials.gov: NCT02823626). Eligible patients were recently hospitalized for heart failure with reduced or preserved ...References1. Vaduganathan M, Kumar V, Voors AA, et al. Unsolved challenges in diuretic therapy for acute heart failure: a focus on diuretic response [Editorial]. Expert Rev Cardiovasc Ther. 2015;13:1075-8. [PMID: 26357970] doi:10.1586/14779072.2015.1087313 CrossrefMedlineGoogle Scholar2. Bansal S, Lindenfeld J, Schrier RW. Sodium retention in heart failure and cirrhosis: potential role of natriuretic doses of mineralocorticoid antagonist?. Circ Heart Fail. 2009;2:370-6. [PMID: 19808361] doi:10.1161/CIRCHEARTFAILURE.108.821199 CrossrefMedlineGoogle Scholar3. Bansal S. New insight in to an old therapy for the treatment of acute decompensated heart failure and associated renal dysfunction. SM Journal of Cardiology and Cardiovascular Diseases. 2016;2:1006. Google Scholar4. Butler J, Anstrom KJ, Felker GM, et al; National Heart Lung and Blood Institute Heart Failure Clinical Research Network. Efficacy and safety of spironolactone in acute heart failure: the ATHENA-HF randomized clinical trial. JAMA Cardiol. 2017;2:950-8. [PMID: 28700781] doi:10.1001/jamacardio.2017.2198 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas Health at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas (S.B., C.V.)Central Michigan University College of Medicine, Saginaw, Michigan (K.M.)University of Texas Health at San Antonio, San Antonio, Texas (S.B., S.B., A.P.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3285.Data Sharing Statement: Deidentified participant data and the informed consent form will be made available to researchers whose proposed use of the data has been approved, for a specified purpose, with investigator support (e-mail, [email protected]edu).This article was published at Annals.org on 16 July 2019. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Shweta Bansal, MD In this video, Shweta Bansal, MD, offers additional insight into the article, "High-Dose Spironolactone When Patients With Acute Decompensated Heart Failure Are Resistant to Loop Diuretics: A Pilot Study." FiguresReferencesRelatedDetails Metrics Cited byMechanistic Insights in Cardiorenal SyndromeRenin-Angiotensin-Aldosterone System Activation and Diuretic Response in Ambulatory Patients With Heart FailureEfficacy and safety of spironolactone for the treatment of patients with acute heart failureBenefits and Risks of Continuing Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Antagonists, and Mineralocorticoid Receptor Antagonists during Hospitalizations for Acute Heart Failure 17 September 2019Volume 171, Issue 6Page: 443-447KeywordsBlood pressureCreatinineDisclosureDiureticsDyspneaEdemaHeart failureInterquartile rangePotassiumWeight loss ePublished: 16 July 2019 Issue Published: 17 September 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...