May 23rd, 2011

Eplerenone Found to Also Reduce AF in Heart Failure Patients

Results from EMPHASIS-HF (Eplerenone and Atrial Fibrillation in Patients with Systolic Heart Failure and Mild Symptoms) previously showed that adding the aldosterone antagonist eplerenone to standard therapy in patients with NYHA class II heart failure resulted in the reduction of the composite endpoint of death from cardiovascular causes or hospitalization for heart failure. Now, a sub-analysis of the trial presented by Karl Swedberg at the Heart Failure Congress 2011 in Gothenburg, Sweden suggests that eplerenone may have the additional beneficial effect of preventing atrial fibrillation (AF) in heart failure patients.

Among the 2737 patients randomized in the trial, 1794 did not have AF at the start of the study. In these patients, new-onset of AF occurred in 2.7% of eplerenone recipients versus 4.5% of placebo recipients (HR 0.58, CI 0.35-0.96, p=0.034).

The investigators also found that eplerenone had similar overall effects in patients both with and without AF at baseline and that AF at baseline did not significantly increase the risk for major study outcomes. However, the rate of total mortality or all-cause hospitalization was higher in the group of patients with AF at baseline than in the patients without AF at baseline (42.2% vs. 35.3%, p=0.008).

The discussant of the trial, Lars Ryden, said that in his opinion eplerenone should join ACE inhibitors and ARBs as recommended agents for the primary prevention of AF in heart failure patients.

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