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European Society of Cardiology

Clinical Articles, Lead Article


The aldosterone antagonist eplerenone significantly reduces new onset atrial fibrillation and flutter (AFF) in patients with class 2 heart failure, according to a sub-analysis1 of the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And Survival Study in Heart Failure) trial presented recently at the European Society of Cardiology’s (ESC) Heart Failure Congress 2011.

Dr Faiez Zannad and colleagues re-analysed data from the EMPHASIS-HF trial, which found significant benefits from eplerenone (Inspra®, Pfizer) versus placebo in 2,737 patients with NYHA class 2 heart failure and ejection fractions of no more than 35%.  In their study Zannad et al explored the development of new onset AFF in patients who had no history at baseline.  The study also set out to determine whether eplerenone worked as well in patients who already had AFF at baseline as those who did not.

Results at an average follow-up of two years showed that new onset AFF occurred in 2.7% of the patients in the group randomised to eplerenone (911) versus 4.5% in the group randomised to placebo (883). The analysis also showed that the risk of cardiovascular death or hospital admission for worsening heart failure, the primary endpoint of the original study, was not significantly different in patients with and without AFF at baseline (p = 0.33).

Commenting on the results study presenter Karl Swedberg, from the University of Gothenburg, Sweden, said, “This latest analysis makes an even stronger case for the use of eplerenone in patients with mild heart failure because in addition to reducing mortality it also reduces the incidence of AF. AF is a condition which both increases morbidity and complicates the care of patients with heart failure”.

Use of eplerenone in patients with mild heart failure, he added, will be considered for inclusion in the ESC guidelines when they are updated at the end of 2011.


1 Zannad F, McMurray JJV, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. New Eng J Med 2011:364:11-21.

Published on: June 8, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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