Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Am Heart J. 2010 Dec;160(6):1156-62. doi: 10.1016/j.ahj.2010.08.036.
The RALES trial demonstrated that spironolactone improved the prognosis of patients with heart failure (HF). However, it is unknown whether the discharge use of spironolactone is associated with better long-term outcomes among hospitalized systolic HF patients in routine clinical practice. We examined the effects of spironolactone use at discharge on mortality and rehospitalization by comparing with outcomes in patients who did not receive spironolactone.
The JCARE-CARD studied prospectively the characteristics and treatments in a broad sample of patients hospitalized with worsening HF and the outcomes were followed with an average of 2.2 years of follow-up.
A total of 946 patients had HF with reduced left ventricular ejection fraction (LVEF) (<40%), among whom spironolactone was prescribed at discharge in 435 patients (46%), but not in 511 patients (54%). The mean age was 66.3 years and 72.2% were male. Etiology was ischemic in 39.7% and mean LVEF was 27.1%. After adjustment for covariates, discharge use of spironolactone was associated with a significant reduction in all-cause death (adjusted hazard ratio 0.612, P=.020) and cardiac death (adjusted hazard ratio 0.524, P=.013).
Among patients with HF hospitalized for systolic dysfunction, spironolactone use at the time of discharge was associated with long-term survival benefit. These findings provide further support for the idea that spironolactone may be useful in patients hospitalized with HF and reduced LVEF.
RALES 试验表明螺内酯可改善心力衰竭（HF）患者的预后。然而，尚不清楚在常规临床实践中，住院收缩性 HF 患者出院时使用螺内酯是否与更好的长期结局相关。我们通过比较未使用螺内酯的患者的结局，来研究出院时使用螺内酯对死亡率和再入院的影响。
JCARE-CARD 前瞻性研究了一组广泛的 HF 恶化住院患者的特征和治疗方法，平均随访 2.2 年。
共有 946 名射血分数降低（LVEF<40%）的 HF 患者出院时开具了螺内酯（435 例，46%），但 511 例（54%）患者未开具螺内酯。患者平均年龄为 66.3 岁，72.2%为男性。病因 39.7%为缺血性，平均 LVEF 为 27.1%。调整协变量后，出院时使用螺内酯与全因死亡（调整后的危险比 0.612，P=.020）和心脏死亡（调整后的危险比 0.524，P=.013）显著降低相关。
在因收缩功能障碍住院的 HF 患者中，出院时使用螺内酯与长期生存获益相关。这些发现进一步支持了螺内酯可能对因 LVEF 降低而住院的 HF 患者有用的观点。
