Withdrawal of Spironolactone for Heart Failure With Improved Ejection Fraction: An Open-Label, Pilot, Randomized...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Optimal management of heart failure (HF) medications after left ventricular ejection fraction (LVEF) improvement is unclear.
• Mineralocorticoid receptor antagonists (MRAs) are key HF therapies, but their long-term use in patients with recovered LVEF requires further study.

Purpose of the Study:

• To assess the feasibility and safety of discontinuing MRAs in HF patients with significantly improved LVEF.
• To evaluate the impact of MRA withdrawal on cardiac function and clinical outcomes.

Main Methods:

• An open-label, randomized controlled pilot trial was conducted.
• 62 HF patients with LVEF improving from ≤35% to ≥50% were randomized to MRA withdrawal or continuation.
• Primary endpoint: LVEF deterioration by ≥10% at 6 months. Secondary endpoints included echocardiographic parameters and natriuretic peptide levels.

Main Results:

• Two patients (6.7%) in the MRA withdrawal group and one (3.2%) in the continuation group showed LVEF deterioration of ≥10%.
• No MRA re-initiation was needed. Echocardiographic parameters and natriuretic peptide levels remained similar between groups at follow-up.
• The study demonstrated a low risk of significant cardiac function decline upon MRA withdrawal.

Conclusions:

• MRA withdrawal is associated with a low risk of cardiac function deterioration in HF patients with improved LVEF (≥50%).
• Discontinuation of MRAs may be a feasible and safe strategy in this specific patient population.