Evidence map›Paper›PMID 21073363›Full record

Trial reportThe New England journal of medicine2011

Eplerenone in patients with systolic heart failure and mild symptoms.

Faiez Zannad, John J V McMurray, Henry Krum, Dirk J van Veldhuisen, Karl Swedberg, Harry Shi, John Vincent, Stuart J Pocock, Bertram Pitt, EMPHASIS-HF Study Group

6 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 942 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
942citing papers in PubMed, 15 pooled it
117.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00232180 phase3completednot on this map

The Effect Of Eplerenone Versus Placebo On Cardiovascular Mortality And Heart Failure Hospitalization In Subjects With NYHA Class II Chronic Systolic Heart Failure

TypeinterventionalSponsorPfizer's Upjohn has merged with Mylan to form Viatris Inc.Ran2006 to 2012Enrolled2,743ConditionsHeart FailureArmsEplerenone
NCT01708798 phase2 / phase3terminatednot on this mapstarted 2014, after this paper: background citation

A Prospective Randomized Placebo-controlled Study of the Effect of Eplerenone on Left Ventricular Diastolic Function in Women Receiving Anthracycline Therapy for Breast Cancer

TypeinterventionalSponsorUniversity of British ColumbiaRan2014 to 2016Enrolled44ConditionsBreast CancerArmsEplerenone, Placebo
NCT01882179 phase3completednot on this mapstarted 2013, after this paper: background citation

MINeralocorticoid Receptor Antagonist Pretreatment to MINIMISE Reperfusion Injury After ST-Elevation Myocardial Infarction (STEMI)

TypeinterventionalSponsorUniversity College, LondonRan2013 to 2016Enrolled61ConditionsST-elevation Myocardial InfarctionArmsMineralocorticoid receptor antagonist potassium-canrenoate, placebo
NCT02344199 completednot on this mapstarted 2015, after this paper: background citation

A Non-interventional, Multicenter, Observational Clinical Trial to Assess Eplerenone Treatment in Patients With Heart Failure.

TypeobservationalSponsorElpen Pharmaceutical Co. Inc.Ran2015 to 2016Enrolled450ConditionsHeart Failure, Acute Myocardial Infarction, Hypertension
NCT05002075 nacompletednot on this mapstarted 2021, after this paper: background citation

Efficacy of an m-Health Cardiac Rehabilitation Program in Heart Failure With Preserved Ejection Fraction: A Pilot Randomized Controlled Trial

TypeinterventionalSponsorUniversity of Texas Southwestern Medical CenterRan2021 to 2024Enrolled69ConditionsHeart Failure With Preserved Ejection FractionArmsm-health cardiac rehabilitation
NCT05593055 phase4recruitingnot on this mapstarted 2023, after this paper: background citation

Mineralocorticoid Receptor, Coronary Microvascular Function, and Cardiac Efficiency in Hypertension

TypeinterventionalSponsorBrigham and Women's HospitalRan2023 to 2027Enrolled75ConditionsHypertension, Left Ventricular HypertrophyArmsEplerenone, Chlorthalidone, Potassium
3 · Its place in the literature

Who cites it

942 citing papers in PubMed, 15 syntheses or guidelines pooled it, 2,999 citations in OpenAlex.

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  3. ASN Kidney Health Guidance on the Cardiovascular-Kidney-Metabolic Syndrome.Journal of the American Society of Nephrology : JASN · 2026
    Guideline
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  9. The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Guideline
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882 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 7 institutions in 6 countries.

Faiez ZannadINSERM, Centre d'Investigation Clinique 9501 and Unité 961, and the Department of Cardiology, Nancy University, Nancy, France. f.zannad@chu-nancy.fr
John J V McMurray
Henry Krum
Dirk J van Veldhuisen
Karl Swedberg
Harry Shi
John Vincent
Stuart J Pocock
Bertram Pitt
EMPHASIS-HF Study Group
Pfizer (United States) · USCentre d’Investigation Clinique Innovation Technologique de Nancy · FRLondon School of Hygiene & Tropical Medicine · GBMonash University · AUUniversity Medical Center Groningen · NLUniversity of Gothenburg · SEUniversity of Michigan–Ann Arbor · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMineralocorticoid antagonists improve survival among patients with chronic, severe systolic heart failure and heart failure after myocardial infarction. We evaluated the effects of eplerenone in patients with chronic systolic heart failure and mild symptoms.

methodsIn this randomized, double-blind trial, we randomly assigned 2737 patients with New York Heart Association class II heart failure and an ejection fraction of no more than 35% to receive eplerenone (up to 50 mg daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.

resultsThe trial was stopped prematurely, according to prespecified rules, after a median follow-up period of 21 months. The primary outcome occurred in 18.3% of patients in the eplerenone group as compared with 25.9% in the placebo group (hazard ratio, 0.63; 95% confidence interval [CI], 0.54 to 0.74; P<0.001). A total of 12.5% of patients receiving eplerenone and 15.5% of those receiving placebo died (hazard ratio, 0.76; 95% CI, 0.62 to 0.93; P=0.008); 10.8% and 13.5%, respectively, died of cardiovascular causes (hazard ratio, 0.76; 95% CI, 0.61 to 0.94; P=0.01). Hospitalizations for heart failure and for any cause were also reduced with eplerenone. A serum potassium level exceeding 5.5 mmol per liter occurred in 11.8% of patients in the eplerenone group and 7.2% of those in the placebo group (P<0.001).

conclusionsEplerenone, as compared with placebo, reduced both the risk of death and the risk of hospitalization among patients with systolic heart failure and mild symptoms. (Funded by Pfizer; ClinicalTrials.gov number, NCT00232180.).

Indexed as

AgedCardiovascular AgentsCardiovascular DiseasesCombined Modality TherapyDefibrillators, ImplantableDouble-Blind MethodEplerenoneFemaleFollow-Up StudiesHeart FailureHospitalizationHumansKaplan-Meier EstimateMaleMiddle AgedMineralocorticoid Receptor AntagonistsCardiovascular AgentsEplerenoneMineralocorticoid Receptor AntagonistsSpironolactone

Identifiers

PMID21073363
OpenAlexW2164705414

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.