The Effect of eplerenone (Inspra) versus placebo on Cardiovascular (heart and blood vessel) mortality (Death) or heart failure hospitalization became much more treatable with the release of the results of the EMPHASIS study today in Chicago. The huge auditorium was hushed as Dr. Zannad described the 25 mg starting dose of eplerenone which was increased to 50 mg and then adjusted based on patient responses and their potassium levels.
Once he had presented the impressive results in the patients with NYHA class two heart failure (24 % decrease in death, 23 % decrease in hospitalization for any reason and 42% decrease in hospitalization from heart failure), he noted that this was a compelling motivation for guidelines to be changed. The discussant (expert in the field who reviewed the study results) was more reserved in her assessment, but did not refute the importance of the study.
Guideline writing and review committees will have strong data that now aligns with the prior two studies involving this existing FDA approved medicine (eplerenone which is an aldosterone antagonist). Patients may benefit from increased use of this medicine based on their individual history and doctor's assessment of the benefits versus the risks (increased potassium) and how it applies to them. Over time, it will be interesting to learn more about how the guideline committees view thie impressive new information and how the guidelines are changed to reflect this new science.