Russian Heart Failure Journal 2008year Effects of spironolactone and digoxin on prognosis in patients with CHF. Results of a 30-year follow-up


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2008/

Effects of spironolactone and digoxin on prognosis in patients with CHF. Results of a 30-year follow-up

Petrukhina A.A., Mareev V.Yu., Skvortsov A.A., Belyavsky E.A., Kheymets G.I., Belenkov Yu.N.

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Urgency. The nature of pharmacotherapy is the most important factor influencing the course and outcome of CHF. Digoxin and spironolactone, the oldest agents for the treatment of CHF may influence the prognosis. Aim. To study the effect of digoxin and spironolactone as a part of multimodality treatment on prognosis in patients with CHF by data of a post hoc study. Materials and methods. The study retrospectively analyzed 1118 case reports of patients with signs of clinically pronounced heart failure (II–IV NYHA FC) who were admitted in the Myasnikov Institute of Clinical Cardiology from 1977 to 1986, from 1987 to 1996, and from 1997 to 2005. Effects of different factors (including digoxin and spironolactone therapy) on long-term prognosis of patients were evaluated. Results. The enhanced neuro-hormonal blockade by addition of spironolactone to the baseline therapy with β-adrenoblocklers and ACEI was not associated with further improvement of prognosis in patients with CHF but rather resulted in a 19% increment of relative risk (RR) for death. At the same time, prognosis of patients receiving spironolactone directly depended on the dose of medicine. In patients receiving spironolactone 12.5–50 mg, RR of death was 14.4 % lower than in patients receiving 75–100 mg. The highest RR of death was observed in patients receiving maximal doses of verospiron (150–400 mg), even compared with patients receiving moderate doses of the aldosterone antagonist. Analysis of the effect of digoxin on prognosis in patients with CHF showed that survival of patients with sinus rhythm depended on the dose of medicine and was significantly better in patients taking ≤0.25 mg of digoxin daily (death RR reduction 42 %; 95 % CI 2.1 %-96.7 %, р=0.035) than in patients taking higher doses of cardiac glycosides. Therefore the treatment with spironolactone in doses higher than 50 mg/day and digoxin in doses higher than 0.25 mg/day as a part of multimodality therapy in combination with ACEI and β-adrenoblockers adversely affects prognosis of patients with clinically pronounced CHF in the setting of routine clinical practice.
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