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We read with dismay the shortcut relating to the underuse of
Spironolactone in American patients with heart failure (JAMA 209;302:1658-
We are pleased to report that patients seen by the Heart Failure
nurses in York are likely to be faring better. Our protocol states that
any patient with New York Heart Association (NYHA) Class III or IV
symptoms and/or severe LV dysfunction should be considered for an
Aldosterone antagonist, either Spironolactone or Eplerenone, once ACE
Inhibitors and Betablockers have been optimised. We have briefly reviewed
the database containing information relating to 731 patients with heart
failure. We found 581 patients fulfilling the criteria for an Aldosterone
antagonist and, of those, 375 (64.5%) who were actually taking it.
Unfortunately, the database does not formally highlight patients that have
been considered for an Aldosterone antagonist but are not taking it for
some reason, for example, patients with contraindications or poor
tolerance. Either way, we think that we can confidently say that the
majority of our patients are considered for and receive an Aldosterone
antagonist where indicated.