TOPCAT misses its primary endpoint: Should spironolactone be abandoned in HFpEF?

Heart failure with preserved ejection fraction (HFpEF) continues to be a challenging form of heart failure – one in which no therapy has yet been proven to improve outcome. Aldosterone antagonists have previously been shown to improve survival in a wide spectrum of patients with heart failure with reduced ejection fraction (HFrEF), and more recently, small trials suggested that they might have role in HFpEF patients. The effect of spironolactone on clinical outcomes in HFpEF was tested in the TOPCAT study.