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Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines

Biykem Bozkurt, MD^*, Ildiko Agoston, MD^* and A. A. Knowlton, MD^,*

^* Winters Center For Heart Failure Research, V A Medical Center, Baylor College of Medicine, Houston, Texas, USA
Cardiology Research, VA Medical Center, Baylor College of Medicine, Houston, Texas, USA

View larger version (38K): [in a new window]   Figure 1 Differences in appropriate patient selection and management with spironolactone according to provider type. The providers are ranked as the staff cardiologist, noncardiology academic staff member, medical resident, satellite clinic nonacademic internist, and the physician assistant. Vertical axis represents the % of patients in our cohort adhering to RALES trial management guidelines for appropriate laboratory follow-up (LAB F/U) (at four weeks and three and six months), New York Heart Association (NYHA) class selection (class III to IV), left ventricular ejection fraction (LVEF) selection (<35%), and the mean daily dose (25 to 50 mg/day) for spironolactone use in patients with heart failure.