ArticleCardiovascular therapeutics2018
Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population.
Article in Cardiovascular therapeutics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 21 citations in OpenAlex.
- Eplerenone, diabetes, and chronic kidney disease in patients hospitalized for acute heart failure: findings from the EARLIER trial.Cardiovascular diabetology · 2025Trial
- Mineralocorticoid Receptor Antagonists, Blood Pressure, and Outcomes in Heart Failure With Reduced Ejection Fraction.JACC. Heart failure · 2020Trial
- Pharmacotherapy in Polish patients with heart failure with reduced ejection fraction: is it optimal?Cardiology journal · 2026Article
- Polypharmacy and Guideline-Directed Medical Therapy Initiation Among Adults Hospitalized With Heart Failure.JACC. Advances · 2024Article
- Evidence for Aldosterone Antagonism in Heart Failure.Cardiac failure review · 2024Review
- Blood pressure in heart failure management and prevention.Hypertension research : official journal of the Japanese Society of Hypertension · 2023Review
- Initiation of Medical Therapy for Heart Failure Patients According to Kidney Function: A Danish Nationwide Study.Clinical epidemiology · 2023Article
- Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction.Drugs in context · 2023Review
- Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population.Open heart · 2022Article
- Giant Renal Artery Aneurysm With Hydronephrosis and Severe Atrophy of the Renal Parenchyma: Case Report and Literature Review.Clinical medicine insights. Case reports · 2022Article
- Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function.PloS one · 2021Observational
- A systematic approach for introduction of novel treatments to a chronic patient group: sacubitril-valsartan as a case study.European journal of clinical pharmacology · 2021Article
- Differences in medical treatment and clinical characteristics between men and women with heart failure - a single-centre multivariable analysis.European journal of clinical pharmacology · 2020Article
- Obstacles to mineralocorticoid receptor antagonists in a community-based heart failure population.Cardiovascular therapeutics · 2018Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
aimPrevious studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (MRA) in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate why MRA is not used to full extent.
methodsA complete community-based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing MRA.
resultsOf 2029 patients, 812 had EF ≤40%. Five hundred and fifty-three patients (68%) tried MRA at some point but 184 of these (33%) discontinued therapy. There were 259 patients that never tried MRA with 177 with a listed explanation or contraindication. Eighty-two patients, 10% of the total HFrEF population, had no clear contraindications. They were older and had less HF hospitalizations compared to patients on MRA (P < 0.05) and 32% did not have any follow-up at the cardiology clinic. Contraindications to MRA were renal dysfunction (93 patients), hypotension (28 patients), and hyperkalemia (25 patients). Only six patients had hyperkalemia without renal dysfunction. Of the patients with renal dysfunction, 66 (72%) had eGFR >30 mL/min.
conclusionsThe reasons why MRA are underutilized were mainly because of contraindications. However, the data suggest that physicians are overly cautious about moderately reduced kidney function. There seems to be a 10%-18% avoidable undertreatment with MRA, especially for elderly patients that are admitted to the hospital for other reasons than heart failure. This suggests that patients with heart failure would benefit from routine follow-up at a cardiology clinic.
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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.