Acute heart failure
MRA efficacy has also been investigated in patients with acute HF. The
ATHENEA-HF trial (Efficacy and safety of spironolactone in acute HF)
showed that the addition of high dose spironolactone to usual care for
patients with acute HF did not change NT-proBNP levels and did not
improve symptoms, congestion and clinical outcomes (Butler et al.,
2017). Moreover, concentrations of spironolactone and its metabolites
were measured in patients receiving high doses of spironolactone,
showing that these concentrations were lower than anticipated (de Denus
et al., 2020). Furthermore, the EARLIER trial (Efficacy and Safety of
Early Initiation of Eplerenone Treatment in patients with acute HF)
demonstrated that although the early initiation of eplerenone treatment
in acute HF patients was safe, the incidence of CV death or
re-hospitalization was not reduced (Asakura et al., 2020).