Conclusions: Patients with HFpEF can be quantified by the TS to capture the likelihood of benefit from spironolactone.Ībstract = "Aims: The TOPCAT trial showed no benefit for spironolactone in heart failure patients with preserved ejection fraction (HFpEF). The cohort of real-world patients with HFpEF had even higher TS than American TOPCAT participants. Spironolactone's benefit rose with rising TS [β interaction = -0.28 (P 1.14), in addition to higher likelihood of HFpEF based on higher H 2FPEF scores (≥3). Those with lower TS showed no significant response to spironolactone. A bimodal distribution of TS separated American (n = 1766) and Eastern European (n = 1,677) participants. The relationship between TS and the H 2FPEF score was also determined in TOPCAT and a registry cohort of real-world patients in the U.S. Logistic regression was used to measure TS and spironolactone as predictors of TOPCAT's primary outcome. Methods and results: From the TOPCAT individual-level data, we calculated a TS of age, body mass index, systolic blood pressure, heart rate, creatinine, potassium, glucose, left ventricular ejection fraction, and left atrial volume for each participant as a weighted distance in multidimensional space from the theoretical perfectly average Americas participant. We aimed to develop a TOPCAT Trial Score (TS) as a composite metric to identify such patients. Determining which patients with HFpEF could respond like TOPCAT's responders should help guide their care.
Post-hoc, spironolactone helped participants from the Americas, but not Eastern Europe. Aims: The TOPCAT trial showed no benefit for spironolactone in heart failure patients with preserved ejection fraction (HFpEF).
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