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The improvement resulted from a reduction in all cause mortality. Spironolactone treatment caused a 30% reduction in mortality compared to placebo (p< 0.001).
Topcat well service trial#
A recent trial evaluated spironolactone in patients with systolic dysfunction heart failure. There are several potential beneficial actions, including prevention of cardiac fibrosis. Spironolactone is a potassium-sparing diuretic that acts on the distal tubule, inhibiting sodium and potassium ion exchange. Aldosterone levels may rise to 20 times normal levels in heart failure and aldosterone contributes to the development of myocardial fibrosis. The renin-angiotensin-aldosterone system is an important part of this compensatory response. The mortality rate was 19% in heart failure patients with reduced systolic function heart failure compared to 4% for their matched controls.Īs heart failure develops, neurohormones are released that initially improve cardiac output but ultimately contribute to progression of left ventricular dysfunction. For instance, Family Health Study participants with heart failure and preserved systolic function had a mortality rate of 9% compared to 3% for their age- and gender-matched controls.
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The annual mortality rate is intermediate between the prognosis for those without heart failure and for those with heart failure and reduced systolic function. Patients with heart failure and preserved systolic function have a poor prognosis. While this treatment has been shown to be useful in treating heart failure with reduced systolic function, it has not been studied in patients with preserved systolic function. This study is a randomized clinical trial of a novel therapeutic approach, specifically the use of spironolactone, an aldosterone antagonist, in treating these patients. However, there is now an emerging awareness that nearly half of the patients with heart failure have preserved systolic function and that the survival of these patients is adversely affected. Therapeutic trials of heart failure have dealt almost exclusively with patients who have systolic dysfunction. As the United States population ages, heart failure will continue to grow as a public health concern. Indeed, it is the most common discharge diagnosis in patients older than 65 years. Heart failure (HF) is a major cause of morbidity and mortality, particularly in older people.