patients involved in the study had severe heart failure (New York Heart Association Class IV) - all patients were being treated with a loop diuretic; most were also being treated with an ACE inhibitor. The ejection fraction of patients was less than 35%
patients were randomised to placebo or spironolactone 25-50mg - other treatments were continued. Potassium levels were monitored regularly throughout the study. The dose of spironolactone was increased to 50mg after one month if serum potassium level allowed
1663 patients with severe heart failure were recruited to the study and the mean follow up was 24 months
in the spironolactone treatment group there was a 30% reduction in all-cause mortality, lowered hospitalisation rates and improved symptomatic control
the incidence of serious hyperkalaemia was uncommon - 1% in the placebo group and 2% in the spironolactone treatment group
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