High-dose spironolactone good option for heart failure patients resistant to loop diuretics

High-dose spironolactone may be a good option for patients with heart failure resistant to treatment with loop diuretics, suggests a small pilot study in the Annals of Internal Medicine.

Diuretics are commonly prescribed for symptom relief in patients with heart failure. Despite rapid relief of symptoms in patients with acute decompensated heart failure, after intravenous use of loop diuretics, the use of these agents has been consistently associated with adverse events, including hypokalemia, azotemia, hypotension, and increased mortality.

Resistance to loop diuretics occurs frequently in patients with acute decompensated heart failure, and secondary hyperaldosteronism plays a major role. Aldosterone antagonists are a standard of care in heart failure but are commonly used at low, nonnatriuretic doses to avoid hyperkalemia.

The researchers conducted a prospective, single-center, nonrandomized trial to ascertain whether the addition of high-dose spironolactone could be safe and effective in selected patients with acute decompensated heart failure.

Nineteen patients hospitalized with acute decompensated heart failure who didn't respond to intravenous furosemide were given high-dose spironolactone, starting at 100 mg per day and increasing up to 200 mg per day.

1. Incidence of hyperkalemia as defined by serum K >5.5 meq/day.


2. Renal function: assessed by daily serum creatinine

1. Weight loss: using the same calibrated scale every day in a hospital gown.


2. Symptom relief: assessed using a 5-point Likert scale describing the magnitude of shortness of breath while the patient is in the supine position.

Overall, patients experienced clinically important weight loss. Fourteen of the 19 experienced reduced dyspnea. None of the patients' potassium levels exceeded 5.5 mmol/L. One patient died following cardiac arrest.

Patient with acute decompensated heart failure who are resistant to loop diuretics presents an immense challenge. Further studies are suggestion that high-dose spironolactone may help in this situation is worthy of further study.