Home > General Cardiology, Journal Club > Journal Club 16 May 2012

Journal Club 16 May 2012

Article

Eplerenone and Atrial Fibrillation in Mild Systolic Heart Failure. Results From the EMPHASIS-HF (Eplerenone in Mild
Patients Hospitalization And SurvIval Study in Heart Failure) Study

Presenter

CJ

PICO

Population

Patients in New York Heart Association functional class II and with ejection fraction 35%

Intervention

Eplerenone at a dose of 25 mg once daily (or 25 mg alternate days if eGFR was 30 to 49 ml/min/1.73 m2)
and increased after 4 weeks to 50 mg once daily (25 mg daily if eGFR was 30 to 49 ml/min/1.73 m2), provided the serum
potassium was no more than 5.0 mmol/l.

Control

Placebo

Outcome

This study examined the incidence of new atrial fibrillation/flutter in this randomized clinical trial

 

Findings

New onset AFF was significantly reduced by eplerenone: 25 of 911 (2.7%) versus 40 of 883 (4.5%) in the placebo
group (hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.35 to 0.96; p  0.034). The reduction in the
primary endpoint with eplerenone was similar among patients with and without AFF at baseline (HR: 0.60, 95%
CI: 0.46 to 0.79 vs. HR: 0.70, 95% CI: 0.57 to 0.85, respectively; p for interaction  0.41). The risk of cardiovascular
(CV) death or hospital admission for worsening heart failure, the primary endpoint, was not significantly
different in subjects with and without AFF at baseline (both study groups combined: HR: 1.23, 95% CI: 0.81 to
1.86; p  0.33).

In patients with systolic heart failure and mild symptoms, eplerenone reduced the incidence of new onset AFF. The
effects of eplerenone on the reduction of major CV events were similar in patients with and without AFF at
baseline

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