Diuretic Inspra sharply reduces deaths in patients with mild heart failure

The diuretic Inspra can reduce deaths and hospitalizations for mild heart failure by 37%, researchers said Sunday, indicating that the drug or others in the class should be more widely used for treating the condition. Inspra, known generically as eplerenone, and the related drug spironolactone are already used to treat patients with more severe heart failure, but the new study, presented at a Chicago meeting of the American Heart Assn. and published online in the New England Journal of Medicine, is the first to show the drug’s value in patients with the milder form of the disease.

The researchers “have added real value to the management of heart failure,” wrote Dr.  Paul W. Armstrong of the University of Alberta in an editorial accompanying the study. “It is now time to overcome undertreatment by ensuring that this form of therapy is incorporated into all heart-failure regimens.”

An estimated 6 million Americans suffer from heart failure, in which the heart slowly loses the ability to pump blood effectively throughout the body. About 30% of those have severe failure, while the rest have a milder form of the disease. Symptoms can include shortness of breath, buildup of fluids in the body and fatigue, among others. Treatment can include a variety of drugs for hypertension and diuretics to remove fluids.

Eplerenone and spironolactone are members of a family of drugs called aldosterone antagonists, which block a hormone that the body uses to hold on to salt (and thus to water).


In the new study, Dr. Faiez Zannad of Nancy University in France and his colleagues studied 2,737 patients, ages 55 or older, with mild heart failure and an ejection fraction of 35% or less. The ejection fraction is the proportion of blood in the ventricles that is pumped out with each contraction of the heart: the normal proportion is about 65%. All were given standard medical therapy; in addition, half were given eplerenone and half a placebo.

The researchers found that the combined risk of hospitalizaton for heart failure or death from cardiovascular disease was 18.3% in the group receiving eplerenone, compared with 25.9% in the placebo group.  The number that was treated to prevent one event in a year was 19, while the number that had to be treated to prevent one death was 51, “positioning this therapy in the front rank of therapeutic choices,” Armstrong wrote.

Armstrong also noted that a reasonable assumption would be that spironolactone would be as effective as eplerenone and that it should be the first choice because it costs only pennies per day, compared with dollars per day for Inspra. The more expensive drug could then be reserved for patients who cannot tolerate spironolactone, he said.