USE OF SPIRONOLACTONE IN SEVERE END-STAGE CONGESTIVE CARDIAC-FAILURE IN ELDERLY PATIENTS - A PILOT-STUDY

Background The aim of the study was to compare the efficacy of spirono lactone and enalapril in severe, resistant congestive cardiac failure (CCF) in elderly patients. Method The study population consisted of 20 patients with severe and refractory CCF (NYHA class 3 and 4). Patient s were allocated randomly to receive either enalapril oi spironolacton e in addition to frusemide. Metalazone was added to the above regime i f needed. Fourteen patients were followed up monthly for 6 months. Ren al function was checked monthly and angiotensin II, aldosterone levels , exercise capacity and quality of life assessed at baseline and after 3 and 6 months. Results Baseline characteristics were similar in the two groups for all variables. Patients administered spironolactone sho wed an increase in aldosterone level with no effect on angiotensin lev el, whereas patients administered enalapril showed a decrease in angio tensin II with no significant effect on aldosterone lever. Patients ad ministered spironolactone showed a significant improvement in almost a ll aspects of quality of life and exercise capacity at months 3 and 6, whereas patients administered enalapril showed improvements only in t erms of decreased social isolation and increased energy. There was no improvement in exercise capacity. Comparison of the two groups at mont h 6 showed significant improvements in physical mobility (P < 0.01), w alking distance (P < 0.05) and ability to do their house work (P < 0.0 5) in patients administered spironolactone compared with patients admi nistered enalapril. Conclusions Combination of frusemide and spironola ctone is an effective treatment for severe CCF in elderly patients. Th is combination gives a better quality of life and exercise capacity th an does a combination of an angiotensin converting enzyme (ACE) inhibi tor and diuretics in severe CCF and should be considered for patients with severe CCF, especially those who can not tolerate ACE inhibitors, those in whom ACE inhibitors are contra-indicated or those whose CCF does not respond to treatment with ACE inhibitors.