Author + information
- Bertram Pitt, MD
We appreciate Dr. Ghali's interest in our report and respond to his specific points as follows:
First, Dr. Ghali suggests excluding patients in the potassium-sparing diuretics (PSD)-only group on beta-blockers because they are more healthy. In fact, beta-blocker use was included in the multivariate analysis in our study. To exclude them from the analysis is not justified, and, in fact, would represent a serious methodological error.
Second, the state of the disease is captured in the New York Heart Association (NYHA) functional class and in the ejection fraction included in the multivariate analysis. The presence or absence of a third heart sound and/or jugular venous distension is subject to substantial potential for ascertainment error and, we believe, would be less reliable than the indicators of disease severity provided.
Finally, although only a prospective randomized study will offer a definitive answer, we believe that emerging data, such as the RALES study with the PSD spironolactone, support our findings.
- American College of Cardiology Foundation