SPIRIT-HF Finds No Clear Benefit of Spironolactone in HFpEF/HFmrEF

SPIRIT-HF found no meaningful reduction in the primary endpoint (HF hospitalizations or cardiovascular death at 24 months) with spironolactone in patients with HFpEF or HFmrEF. The spironolactone group had more total hospitalizations and adverse events (hypotension, renal issues, hyperkalemia). A high COVID-19–related discontinuation and limited power may have muted efficacy signals; a meta-analysis with TOPCAT also showed no significant benefit, though ongoing registries may clarify safety and efficacy.