Study shows eplerenone significantly reduced the incidence of new onset atrial fibrillation

The pre-specified sub-analysis of a new study, eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) showed that eplerenone, when added to standard recommended therapy, significantly reduced the incidence of new onset atrial fibrillation (AF) and atrial flutter (AFL) in patients with systolic heart failure and mild symptoms compared with placebo plus standard therapy.

The EMPHASIS-HF trial enrolled 2,737 subjects with chronic systolic heart failure (NYHA class 2) and mild symptoms. The sub-analysis looked at subjects without a history of AF/AFL based on the baseline ECG and physical examination (911 in the eplerenone group and 883 in the placebo group). New onset AF/AFL occurred in 25 (2.7%) patients in the eplerenone group versus 40 (4.5%) patients in the placebo group.

The latest findings add to the already positive results of the EMPHASIS-HF trial published in the New England Journal of Medicine. Eplerenone, an aldosterone antagonist, had proven to be effective in reducing the risk of death or hospitalizations due to heart failure. The promising results have led its maker, Pfizer, to make the drug available in Singapore.

The results showed that eplerenone in comparison to placebo produced a 37% reduction in the primary end point of the composite of death from cardiovascular causes or hospitalization for heart failure, a 24% reduction in cardiovascular death, and a 42% reduction in hospitalization for heart failure for patients with class 2 or mild heart failure.

Aldosterone antagonists have long been a mainstay in the treatment regimen of those with moderate to severe heart failure. However, according to Dr Bernard Kwok, Consultant Cardiologist from Mount Elizabeth Medical Centre, and President of the Singapore Cardiac Society, “The results of this study indicate that eplerenone should be extended to a larger population of those suffering from systolic heart failure. Those who have been diagnosed with mild heart failure also stand to benefit from this treatment.”

Heart failure may be caused by several factors including myocardial infarctions and hypertension. In Singapore, 7,143 new cases of acute myocardial infarctions were seen in 2008 alone. While the latest 2010 National Health Survey has revealed that almost one in four Singaporeans suffer from hypertension.