Ferreira JP, Liu J, Claggett BL, et al. - A frequent occurrence of outpatient diuretic intensification (ODI) was evident in patients with heart failure (HF) and a preserved ejection fraction (HFpEF), and also ODI independently related to subsequent cardiovascular events in such patients. An extended composite outcome incorporating ODI was significantly reduced by treatment with spironolactone.

• Participants included 1,767 patients enrolled in TOPCAT-Americas, in whom the frequency, prognostic impact, as well as the effect of spironolactone on ODI was examined.

• ODI occurred in 38.8% of patients and was linked with a higher risk of subsequent cardiovascular events and death [adjusted hazard ratio (HR) for HF hospitalization or cardiovascular death 1.67; HR for cardiovascular death 2.17); and HR for all-cause death 1.75].

• Use of spironolactone resulted in a 26% relative decrease of the extended composite of ODI or HF hospitalization or cardiovascular death (HR 0.74) vs a 16% relative decrease of HF hospitalization or cardiovascular death (HR 0.84).