Problem CCF (NYHA II & EF < 35%*)
Format Double-blinded multi-center RCT
Treatment Eplerenone
Control Placebo
Population 2737 patients
Inclusion criteria Age > 55 years
NYHA functional class II symptoms
Ejection fraction of no more than 30% (or, if >30 to 35%, a QRS duration of >130 msec)
Treatment with an angiotensin-converting–enzyme (ACE) inhibitor, an angiotensin-receptor blocker (ARB), or both and a beta-blocker (unless contraindicated) at the recommended dose or maximal tolerated dose.
Exclusion criteria Acute myocardial infarction
NYHA class III or IV heart failure
Serum potassium > 5.0 mmol per liter
eGFR < 30 ml per minute per 1.73 m2
Need for a potassium-sparing diuretic
Any other clinically significant, coexisting condition.
Follow-up Median 21 months
Primary endpoint Composite of death from cardiovascular causes or a first hospitalization for heart failure
Secondary endpoint(s) Hospitalization for heart failure or death from any cause
Death from any cause
Death from cardiovascular causes
Hospitalization for any reason
Hospitalization for heart failure (among others)
Details * = Ejection fraction of no more than 30% (or, if >30 to 35%, a QRS duration of >130 msec)

Patients were randomized to two placebo or eplerenone 25 mg once daily. This dosage increased to 50 mg once daily after 4 weeks or 25 mg on alternate days increased to 25 mg daily. Serum potassium levels were used to guide dose increases and decreases.
Brief summary: Eplereonone reduced mortality and symptoms in NYHA 2+
PAPER: Eplerenone in patients with systolic heart failure and mild symptoms.
Date 6 Jan 2011
Journal N Engl J Med. 2011 Jan 6;364(1):11-21.
Information Eplerenone vs. placebo
-37% reduction in death from CV causes or hospitalisation for HF
--Benefits across all prespecified subgroups

-Significant reduction in death from any cause

-Trend towards fewer adverse events in eplerenone group
--Significantly increased risk of hyperkalaemia