Pilot Study on Withdrawal of Spironolactone Among Heart Failure With Improved Ejection Fraction

Inclusion criteria

• Willing and capable of providing informed consent and agrees to follow the study protocol and schedule of clinical follow-up
• Age between 19 and 80 years old
• Prior diagnosis of heart failure with reduced left ventricular ejection fraction (LV EF ≤ 35%) and on medical therapy including spironolactone combined with angiotensin-converting enzyme or angiotensin receptor blocker or antiotensin receptior neprilysin blocker, beta-blocker.
• LV EF ≥ 50% documented with echocardiography performed within a month
• Documented result of BNP or NT-proBNP level within a month

Exclusion criteria

• Dyspnea ≥ New York Heart Association (NYHA) functional class III
• Patients who need to discontinue spironolactone owing to prior adverse event
• Primary valvular heart disease with at least moderate degree
• Estimated glomerular filtration rate less than 30 mL/min per 1.73 m2
• Uncontrolled hypertension defined as blood pressure more than 140/90 mmHg
• Presence of other clinical reason to continue spironolactone such as myocardial infarction, primary aldosteronism, and liver cirrhosis
• Hyperkalemia defined as serum potassium level less than 3.5 mmol per liter
• Pregnant and/or lactating women
• Life expectancy less than a year
• Patients who are not suitable to enrollment by investigator's discretion