Related Experiment Videos
Long-term therapy with spironolactone
M L Bouvy1, E R Heerdink, R M Herings
1Department of Pharmacoepidemiology & Pharmacotherapy, Faculty of Pharmacy, Utrecht University, The Netherlands. m.bouvy@pharm.uu.nl
Insights
Spironolactone therapy discontinuation is common in heart failure patients, with over half stopping treatment. Maintaining combination therapy with ACE inhibitors also proves challenging for many patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Spironolactone is a medication used in heart failure management.
- Understanding real-world adherence to spironolactone therapy is crucial.
Purpose of the Study:
- To evaluate the duration of spironolactone therapy in routine clinical practice.
- To assess the persistence of spironolactone use and combination therapy with ACE inhibitors.
Main Methods:
- Retrospective cohort study of patients with heart failure (CHF) and a new spironolactone prescription.
- Follow-up of patient therapy duration and discontinuation rates.
Main Results:
- 58.8% of patients discontinued spironolactone, with 40.8% discontinuing within 6 months.
- Concomitant use of spironolactone and ACE inhibitors was difficult to maintain, with high rates of discontinuation for one or both drugs.
- Average starting dose of spironolactone was 55 mg, higher than in clinical trials.
Conclusions:
- High rates of spironolactone discontinuation suggest challenges in long-term patient adherence.
- Maintaining combination therapy with spironolactone and ACE inhibitors is difficult in practice.
- Higher initial dosages may contribute to adverse effects and discontinuation.
Objective:
To evaluate the duration of therapy with spironolactone in daily practice.
Method:
A retrospective follow-up of a cohort of patients with a first prescription for spironolactone between January 1, 1990 and December 31, 1996 and at least one hospital discharge for CHF in the preceding year.
Results:
243 patients met the inclusion criteria and were followed until the end of data collection. The average starting dosage of spironolactone was 55 mg. 143 patients (58.8%) discontinued spironolactone therapy before the end of follow-up. 98 patients (40.8%) discontinued within 6 months of follow-up. Of the 137 patients (56.4%) who did use spironolactone and an ACE-inhibitor concomitantly, only 45 (32.8%) continued this combination until the end of follow-up. The remainder of the patients discontinued either the ACE-inhibitor (10.9%) or spironolactone (12.4%) or both (43.8%).
Conclusion:
While the reasons for discontinuation remain unclear, our data suggest that it is difficult to keep patients on both drugs. It is not certain whether these findings from past spironolactone use can be extrapolated to future use. Patients in the general population received higher average spironolactone dosages compared to the RALES study (55 mg vs. 26 mg), possibly resulting in more adverse effects and partly explaining the high discontinuation rate.