Author + information
- Wojciech Kosmala, MD, PhD and
- Thomas H. Marwick, MBBS, PhD, MPH∗ ()
- ↵∗Baker IDI Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria 3004, Australia
We appreciate the interest of Drs. Lewis and Miller in our trial of patients with heart failure with preserved ejection fraction (HFpEF) (1). This study of patients with an increment of filling pressure with exercise showed an improvement in exercise tolerance with spironolactone therapy. This observation is consistent with our previous meta-analysis (2) and represents a narrative contrary to the widely accepted therapeutic nihilism about this condition.
Thus, we entirely share the opinion that the demographic and clinical characteristics of patients with HFpEF mandates deeper consideration of the most appropriate primary outcomes in clinical trials of this condition. This notion is consistent with a statement included in the latest heart failure guidelines that “since these patients are often elderly and highly symptomatic, and often have a poor quality of life, an important aim of therapy may be to alleviate symptoms and improve well-being” (3). This provides a rationale for taking into account other clinically relevant aspects, including functional capacity and quality of life.
Failure to demonstrate improvement in survival should not exclude a treatment modality from being considered as a valuable therapeutic option if there are other clinical benefits. The importance of this lesson may not be limited to HFpEF populations. As we deal with aging, comorbidity, and frailty among increasing numbers of our patients, we should listen more to what they tell us about their goals of care.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
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