Spironolactone belongs to a family of drugs called ‘mineralocorticoidreceptor antagonists’. These drugs have been proven as effective in reducing the risk of death and hospitalization for people with symptomatic heart failure with reduced left-ventricular ejection fraction (HFrEF) but they have not been tested in people with preserved ejection fraction (Spironolactone; RALES 1999 and Eplerenone; EMPHASIS 2011).

In 2013, an international heart failure trial called TOPCAT investigated using spironolactone for heart failure and preserved ejection fraction (LCEF≥ 45%) but the results were not clear. Regional variations in the way participants were recruited and difficulties in ensuring that patients were taking the required treatments led to results that, at best, could be considered ‘neutral’ – the team couldn’t tell if there was an effect or not. However, spironolactone did seem to show a potential benefit among the American patients recruited.

Now, the DZHK want to carry out a more robust trial, testing a mineralocorticoid receptor blocker in people suffering from heart failure with mid‐range ejection or preserved left ventricular ejection fraction.