What were the findings of the TOPCAT trial?
The Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial was a randomized, double-blind, placebo-controlled trial conducted to evaluate the effect of spironolactone in patients with heart failure and preserved ejection fraction. The primary outcome of the trial, which included 3,445 patients, was a composite of cardiovascular death, aborted cardiac arrest, or hospitalization due to heart failure. The findings of the trial were that spironolactone did not significantly reduce the primary outcome compared to placebo (relative risk 0.93; 95% CI 0.82-1.05; p=0.22). However, spironolactone did reduce all-cause mortality (relative risk 0.87; 95% CI 0.77-0.98; p=0.03). 