| Eplerenone | heart failure, in all type of patients | vs placebo | death from cardiovascular causes or hospitalization for cardiovascular causes by 11% suggested serious hyperkalemia by 63% suggested Sudden death by 20% suggested Death from any cause or hospitalization for any reason by 18% suggested Death from any cause or hospitalization for heart failure by 28% suggested Cardiovascular death by 17% suggested hospitalisation for heart failure by 35% suggested All cause death by 15% suggested Hospitalization for any reason by 16% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | 0.93 [0.82 1.05] | p=1.00 | 0 | 6632 | 1 | EPHESUS, | | death from cardiovascular causes or hospitalization for cardiovascular causes | 0.89 [0.80 0.99] | p=0.04 | 0 | 6632 | 1 | EPHESUS, | | serious hyperkalemia | 1.63 [1.35 1.98] | p=0.04 | 0 | 9369 | 2 | EPHESUS, EMPHASIS-HF, | | Sudden death | 0.80 [0.67 0.96] | p=0.04 | 0 | 9369 | 2 | EPHESUS, EMPHASIS-HF, | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | 0.82 [0.70 0.95] | p=0.04 | 0 | 2737 | 1 | EMPHASIS-HF, | | exacerbation of heart failure | no data | | NYHA class improvement | no data | | Death from any cause or hospitalization for heart failure | 0.72 [0.60 0.86] | p=0.04 | 0 | 2737 | 1 | EMPHASIS-HF, | | Cardiovascular death | 0.83 [0.74 0.94] | p=0.04 | 0 | 9369 | 2 | EPHESUS, EMPHASIS-HF, | | hospitalisation for heart failure | 0.65 [0.53 0.81] | p=0.04 | 0 | 2737 | 1 | EMPHASIS-HF, | | All cause death | 0.85 [0.76 0.95] | p=0.04 | 0 | 9369 | 2 | EPHESUS, EMPHASIS-HF, | | Hospitalization for any reason | 0.84 [0.71 0.98] | p=0.04 | 0 | 2737 | 1 | EMPHASIS-HF, | | Adverse events leading to treatment discontinuation | no data | | Adverse events | 0.99 [0.90 1.09] | p=1.00 | 0 | 9369 | 2 | EPHESUS, EMPHASIS-HF, |
| Trial | Studied treatment | Control | Patients |
|---|
| EPHESUS, 2003 | eplerenone 25 mg per day initially, titrated to amaximum of 50 mg per day | placebo | patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure | | EMPHASIS-HF, 2010 | eplerenone | placebo | patients with
New York Heart Association class II heart failure and an ejection fraction of no
more than 35% |
| |
| Spironolactone | heart failure, in all type of patients | vs control | all NS | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | no data | | death from cardiovascular causes or hospitalization for cardiovascular causes | no data | | serious hyperkalemia | no data | | Sudden death | no data | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | no data | | exacerbation of heart failure | no data | | NYHA class improvement | no data | | Death from any cause or hospitalization for heart failure | no data | | Cardiovascular death | no data | | hospitalisation for heart failure | no data | | All cause death | no data | | Hospitalization for any reason | no data | | Adverse events leading to treatment discontinuation | no data | | Adverse events | no data |
| Trial | Studied treatment | Control | Patients |
|---|
| Cicoira, 2004 | spironolactone | control | chronic heart failure patients | | Cicoira, 2002 | spironolactone 12.5 to 50 mg/day | control | patients with chronic heart failure | | Ramires, 2000 | spironolactone | standard medical treatment | patients with systolic dysfunction and NYHA class III CHF secondary to dilated or ischemic cardiomyopathy |
| |
| Spironolactone | | vs placebo | Adverse events leading to treatment discontinuation by 59% adverse event hospitalisation for cardiovascular causes by 21% suggested exacerbation of heart failure by 21% suggested NYHA class improvement by 24% suggested Cardiovascular death by 26% suggested All cause death by 25% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | 0.79 [0.65 0.97] | p=0.04 | 0 | 1663 | 1 | RALES, | | death from cardiovascular causes or hospitalization for cardiovascular causes | no data | | serious hyperkalemia | 2.05 [0.19 22.61] | p=1.00 | 0 | 1663 | 1 | RALES, | | Sudden death | 0.76 [0.56 1.03] | p=1.00 | 0 | 1663 | 1 | RALES, | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | no data | | exacerbation of heart failure | 0.79 [0.65 0.96] | p=0.04 | 0 | 1663 | 1 | RALES, | | NYHA class improvement | 1.24 [1.02 1.51] | p=0.04 | 0 | 1663 | 1 | RALES, | | Death from any cause or hospitalization for heart failure | no data | | Cardiovascular death | 0.74 [0.61 0.91] | p=0.04 | 0 | 1663 | 1 | RALES, | | hospitalisation for heart failure | no data | | All cause death | 0.75 [0.62 0.92] | p=0.04 | 0 | 1663 | 1 | RALES, | | Hospitalization for any reason | no data | | Adverse events leading to treatment discontinuation | 1.59 [1.05 2.39] | p=0.04 | 0 | 1663 | 1 | RALES, | | Adverse events | 1.03 [0.81 1.32] | p=1.00 | 0 | 1663 | 1 | RALES, |
| Trial | Studied treatment | Control | Patients |
|---|
| RALES, 1998 | spironolactone (25 to 50 mg daily) | placebo | patients with severeheart failure | | Agostoni, 2005 | spironolactone 25mg/d | placebo | stable chronic heart failure patients with reduced influences lung diffusion (DLCO) | | Mottram, 2004 | spironolactone 25 mg/d | placebo | hypertensive patients with diastolic heart failure | | Macdonald, 2004 | spironolactone 12.5-50 mg/d | placebo | patients with New York Heart Association class I-II congestive heart failure taking optimal treatment (including beta blockers) | | Yee, 2001 | spironolactone 50mg/d | placebo | patients with New York Heart Association class II to IV congestive heart failure | | Tsutamoto, 2001 | spironolactone 25 mg daily | placebo | patients with mild-to-moderate nonischemic congestive heart failure | | Farquharson, 2000 | spironolactone 50 mg/d | placebo | patients with NYHA class II to III chronic heart failure on standard diuretic/ACE inhibitor therapy | | MacFadyen, 1997 | spironolactone (50-100 mg/day) | placebo | patients with stable chronic heart failure |
| |
| Spironolactone | | vs captopril | all NS | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | no data | | death from cardiovascular causes or hospitalization for cardiovascular causes | no data | | serious hyperkalemia | no data | | Sudden death | no data | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | no data | | exacerbation of heart failure | no data | | NYHA class improvement | no data | | Death from any cause or hospitalization for heart failure | no data | | Cardiovascular death | no data | | hospitalisation for heart failure | no data | | All cause death | no data | | Hospitalization for any reason | no data | | Adverse events leading to treatment discontinuation | no data | | Adverse events | no data |
| Trial | Studied treatment | Control | Patients |
|---|
| Han, 1994 | captopril plus spironolactone | captopril alone | patients with refractory CHF and New York Heart Association functional class IV without renal dysfunction, hypotension and hyperkalemia |
| |
| Spironolactone | | vs furosemide | all NS | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | no data | | death from cardiovascular causes or hospitalization for cardiovascular causes | no data | | serious hyperkalemia | no data | | Sudden death | no data | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | no data | | exacerbation of heart failure | no data | | NYHA class improvement | no data | | Death from any cause or hospitalization for heart failure | no data | | Cardiovascular death | no data | | hospitalisation for heart failure | no data | | All cause death | no data | | Hospitalization for any reason | no data | | Adverse events leading to treatment discontinuation | no data | | Adverse events | no data |
| Trial | Studied treatment | Control | Patients |
|---|
| Bednarz, 2000 | Aldactone 200 mg i.v | furosemide 20 mg i.v | patients with NYHA class III to IV congestive heart failure |
| |
| Spironolactone | | vs spironolactone+butizide | all NS | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| hospitalisation for cardiovascular causes | no data | | death from cardiovascular causes or hospitalization for cardiovascular causes | no data | | serious hyperkalemia | no data | | Sudden death | no data | | death from cardiovascular causes or hospitalization for heart failure | no data | | Death from any cause or hospitalization for any reason | no data | | exacerbation of heart failure | no data | | NYHA class improvement | no data | | Death from any cause or hospitalization for heart failure | no data | | Cardiovascular death | no data | | hospitalisation for heart failure | no data | | All cause death | no data | | Hospitalization for any reason | no data | | Adverse events leading to treatment discontinuation | no data | | Adverse events | no data |
| Trial | Studied treatment | Control | Patients |
|---|
| Mauersberger, 1985 | spironolactone 50mg + furosemide 20 mg | spironolactone 50mg + butizide 5mg | patients with congestive heart failure |
| |
