Japan: Eplerenone Treatment and Clinical Stability in Acute Heart Failure

Treatment with eplerenone improves clinical stability, especially during the short period after hospitalization for acute heart failure (AHF); this is the key finding from a study featured in the International Journal of Cardiology.

The clinical stability was shown by the lower diuretic doses (both in-hospital and out-of-hospital settings), decreased natriuretic peptide levels, and improved echocardiographic markers of congestion and LV volume. Higher diuretic doses were linked with a risk of HF-related events and more severe congestion.

Eplerenone was not shown to reduce all-cause mortality or heart failure hospitalizations in 300 patients admitted for acute heart failure in the EARLIER (Efficacy and Safety of Early Initiation of Eplerenone Treatment in Patients with Acute Heart Failure) trial. The trial, however, might have been underpowered for these endpoints, and a comprehensive overview of eplerenone's effect on the clinical stability of the patient and diuretic disease is warranted.

The EARLIER trial comprised Japanese patients hospitalized for acute heart failure. They were randomly assigned to eplerenone or placebo for over six months. Mixed-effects models and Cox proportional hazards were used for analyses.

Findings

• The study included three hundred patients (mean age, 67 ± 13 years; 73% were males). At randomization, the median furosemide equivalent dose was 40 mg.
• Patients with higher furosemide-equivalent doses had more severe signs and symptoms of congestion and a higher risk of all-cause mortality or HF hospitalization during 6-month follow-up (adjusted-hazard ratio per 10 mg/day increase = 1.25).
• Eplerenone significantly decreased furosemide-equivalent diuretic doses and b-type natriuretic levels throughout the follow-up and reduced E/e' and inferior vena cava diameter at four weeks.
• Additionally, eplerenone significantly reduced left ventricular (LV) end-diastolic diameter at 24 weeks.

"Eplerenone treatment improved clinical stability, especially during a short period after hospitalization for acute heart failure, translated by lower natriuretic peptide levels, diuretic doses, smaller LV volume, and indirect markers of filling pressure and venous congestion," Masatake Kobayashi, from Tokyo Medical University in Tokyo, Japan, and colleagues wrote.

Reference

The study, "Effect of eplerenone on clinical stability of Japanese patients with acute heart failure," was published in the International Journal of Cardiology.

DOI: https://doi.org/10.1016/j.ijcard.2022.12.045