Greene SJ, et al. - Considering the ATHENA-HF trial, wherein, 360 acute HF (AHF) patients with reduced or preserved ejection fraction were randomized to spironolactone 100 mg daily or usual care for 96 hours, researchers perfomed this current analysis to evaluate the impacts of study therapy within tertiles of baseline estimated glomerular filtration rate (eGFR) and subgroups at heightened risk for diuretic resistance. They found that among AHF patients, no improvement in congestion was observed with high-dose spironolactone as compared with usual care, irrespective of renal function and risk factors for diuretic resistance. Furthermore, during the inpatient stay, it was safe to implement in-hospital initiation or continuation of spironolactone even when administered at high doses to patients with moderate renal dysfunction.