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Laboratory Monitoring Inadequate in Heart Failure Patients Treated with Spironolactone: Presented at AHA

By Jill Stein

DALLAS, TX -- November 14, 2005 -- Investigators are calling for more conscientious monitoring of potassium and creatinine concentrations in patients receiving spironolactone for heart failure.

Keyur B. Shah, MD, Resident in Internal Medicine, University of Maryland, Baltimore, Maryland, United States, issued his group's recommendation based on a study that found that laboratory monitoring is insufficient in these patients despite the fact that hyperkalemia and renal dysfunction are common.

"Systems need to be in place to assure that patients receiving spironolactone are carefully selected and closely monitored," Dr. Shah said here on November 13^th at the American Heart Association's Scientific Sessions 2005 (AHA).

Dr. Shah and colleagues reviewed the charts of 840 heart failure patients who had been started on spironolactone therapy after the publication of the Randomized Aldactone Evaluation Study results. The RALES study demonstrated a 30% mortality benefit with spironolactone for severe heart failure.

Of the study cohort, 91% had baseline laboratory values and 66% had serum potassium or creatinine levels obtained within 3 months after the start of spironolactone treatment.

In the group that had follow-up values, 15% developed hyperkalemia and 6% developed severe hyperkalemia.

Among 138 patients with baseline serum creatinine 1.5 mg/dL or greater, hyperkalemia developed in 35%, and among 19 with baseline creatinine 2.5 mg/dL or greater 63% developed hyperkalemia.

Dr. Shah said the data show that hyperkalemia with spironolactone is a common occurrence and surveillance of these patients is poor.

"Limiting hyperkalemia and potential deadly arrhythmias requires close monitoring after initiating therapy," he noted. "Patients with increased renal impairment, even minor renal impairment, require close surveillance."

The investigator also called for physician education about the risks of spironolactone therapy and the importance of close follow-up.


[Presentation title: The Adequacy of Laboratory Monitoring in Patients Treated with Spironolactone for Congestive Heart Failure. Abstract 1747]

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