Harvard Heart Letter

Slow adoption of helpful heart failure drug

Many people who could benefit from spironolactone aren't getting it.

In 1999, a large clinical trial showed that a drug called spironolactone (spih-row-noe-LACK-tone) could improve symptoms and lengthen life in some people with heart failure. More than 10 years later, only a minority of those who could benefit from the drug are taking it, even though it is inexpensive and guidelines for treating heart failure recommend its use.

To get a handle on the use of spironolactone (sold as generic spironolactone or as brand-name Aldactone), a national team of researchers reviewed medical records of 12,565 men and women with heart failure — all prime candidates for spironolactone therapy — who were discharged from 201 hospitals over a three-year period. Only 4,087 (33%) were given a prescription for the drug (Journal of the American Medical Association, Oct. 21, 2009). Since all of these hospitals were taking part in the American Heart Association's Get With The Guidelines program, it is likely that the appropriate use of the drug in the community is even lower.

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