Prevention

Why?

• It reduces mortality and admissions to hospital, and improves symptoms, without clearly increasing the incidence of severe hyperkalaemia. ^a
• It can cause intolerable side-effects, including gynaecomastia in men. ^a

Spironolactone reduces death, hospital admissions and improves symptoms

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
severe heart failure (LV ejection fraction < 35%)	spironolactone	placebo	death at 24 months	46%	25% (15% to 33%)	9 (61 to 15)
			hospitalisation due to heart failure at 24 months	36%	27% (15% to 37%)	11 (7 to 20)
			improvement in NYHA class at 24 months	33%	24% (9% to 41%)	13 (8 to 30)
			discontinuation of medication due to adverse event at weeks	4.8%	-59% (-130% to -8%)	-36 (-210 to -20)
			gynaecomastia in men at 24 months	0.95%	-600% (-1370% to -240%)	-17 (-26 to -13)