Clinical benefits of Eplerenone in patients with systolic NYHA II heart failure when initiated shortly after hospital discharge

Purpose: Cardiovascular hospitalization (CVH) in patients with heart failure (HF) is associated with a high post-discharge rate of re-admission and CV death. Eplerenone might be effective in reducing the incidence of these adverse clinical outcomes. Methods: The EMPHASIS-HF trial compared eplerenone to placebo added to standard therapy in 2737 patients with NYHA class II HF and LV ejection fraction <35%. In a post-hoc analysis in the 2338 patients randomized within 180 days of a CVH, we assessed the interaction between the time from the index CVH to randomization and the primary outcome of CV death or hospitalization for HF (HHF) using multivariable Cox survival models. Results: Most of the index CVH were HHF (N=1496, 64.0%) and acute coronary syndromes (N=390, 16.7%). The median time from index CV event was 42 days. In the <42 days group, median time since index CV event was 12 days and interquartile range was 5 to 26 days. The relative risk reductions in CV death/HHF, HHF and all-cause mortality were similar (p for interaction=0.65, 0.44 and 0.40 respectively) whether treatment was initiated <42 days or 42+ days after index CV event. Because event rates were higher in the <42 days group (14.1% in the <42 days group vs 11.8% in the 42+ days group for CV death/HHF), this subgroup had higher absolute risk reductions (11.4% in Eplerenone arm versus 17.0% in the placebo arm in the <42 days group, 10.0% versus 13.6% in the 42+ days group). ![Figure][1] Survival curves for CV death or HFH Conclusion: Eplerenone improves survival and prevents readmission when initiated relatively soon after a hospitalization for HF or acute coronary syndromes in patients with NYHA class II systolic HF. [1]: pending:yes