{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:44:39Z","timestamp":1789184679636,"version":"build-2803163510"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,7,16]]},"abstract":"<jats:sec id=\"jah39874-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome increasing in prevalence and affecting millions worldwide but with limited evidence\u2010based therapies. Results from explanatory clinical trials suggest that spironolactone may help to improve outcomes in patients with HFpEF. We sought to investigate the effectiveness of spironolactone in reducing death and hospitalization outcomes for patients with HFpEF in a real\u2010world setting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah39874-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We used electronic health records from the US Veterans Affairs (VA) health care system between 2002 and 2012 to identify patients with HFpEF who were followed longitudinally through 2014 using a validated algorithm. Among our HFpEF cohort that is 96% men, 85% White individuals, and aged 74\u00b111\u2009years, 3690 spironolactone users and 49\u2009191 nonusers were identified and followed for a median of 2.9 (interquartile range [IQR], 1.5\u20132.4) and 3.3 (IQR, 1.6\u20135.9) years, respectively. We evaluated the effect of spironolactone use on all\u2010cause death and number of days hospitalized per year for heart failure or for any cause by fitting generalized estimating equation\u2013based Poisson and negative binomial models. Crude rates of 10.3 versus 13.5 deaths and 394.0 versus 485.9\u2009days hospitalized were observed per 100 person\u2010years for spironolactone users versus nonusers, respectively. After multivariable adjustment, there was a 21% reduction (95% CI, 13\u201329;\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.0001) in rate of all\u2010cause death among spironolactone users compared with nonusers and no statistically significant difference in days hospitalized for all causes or heart failure.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah39874-sec-0003\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In a real\u2010world national cohort of patients with HFpEF, spironolactone use reduced all\u2010cause death and demonstrated a favorable trend in reducing the burden of hospitalizations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032231","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T11:57:37Z","timestamp":1720526257000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Spironolactone Reduces the Risk of Death in Veterans With Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9357-0034","authenticated-orcid":false,"given":"Katherine E.","family":"Kurgansky","sequence":"first","affiliation":[{"name":"Veterans Affairs Boston Healthcare System","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-7293","authenticated-orcid":false,"given":"Rachel","family":"Parker","sequence":"additional","affiliation":[{"name":"Veterans Affairs Boston Healthcare System","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9902-3047","authenticated-orcid":false,"given":"Luc","family":"Djousse","sequence":"additional","affiliation":[{"name":"Veterans Affairs Boston Healthcare System","place":["Boston"]},{"name":"Harvard Medical School","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6367-3179","authenticated-orcid":false,"given":"David R.","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Veterans Affairs Boston Healthcare System","place":["Boston"]},{"name":"Boston University School of Public Health","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-4896","authenticated-orcid":false,"given":"Jacob","family":"Joseph","sequence":"additional","affiliation":[{"name":"Veterans Affairs Boston Healthcare System","place":["Boston"]},{"name":"VA Providence Healthcare System","place":["Providence"]},{"name":"Warren Alpert Medical School","place":["Providence"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052256"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.11.036"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011942"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2017.65"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2014.04.003"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.080770"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22853"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12989"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0516"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1470320313481485"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(15)00257-3"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2018.11.16"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-018-9758-0"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014967"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14940"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.905"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1612601"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw114"},{"key":"e_1_3_1_25_2","unstructured":"ClinicalTrials.gov. 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