ReviewCJC open2025
The Effect of Mineralocorticoid Receptor Antagonists on Heart Failure with Nonreduced Ejection Fraction: A Systematic Review and Meta-Analysis.
Review in CJC open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
- Erratum issued
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The recommendations for mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with nonreduced ejection fraction (HFnrEF), defined as heart failure with left ventricular ejection fraction > 40%, are not clear. This systematic review and meta-analysis aims to evaluate the effect of MRAs on patient-important outcomes in HFnrEF. Methods: We searched MEDLINE, Embase, Cochrane Database/Register from inception to September 6, 2024, for all randomized controlled trials comparing MRAs to placebo/standard of care in HFnrEF. Fixed and random effects models pooled estimates for mortality (all-cause and cardiovascular), HF hospitalization (HFH), functional capacity, health-related quality of life, and adverse outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty-of-evidence assessments. Results: Eight RCTs reported on 10,313 patients with HFnrEF. Compared to placebo or standard of care, MRAs result in a reduction in HFH (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.76-0.91; risk difference [RD] 29 fewer per 1000, 95% CI 31 fewer to 15 fewer; high certainty). Moderate-certainty evidence suggests that MRAs probably result in a slight reduction in all-cause mortality (RR 0.93, 95% CI 0.85-1.02; RD 11 fewer per 1000, 95% CI 23 fewer to 3 more) and cardiovascular mortality (RR 0.92, 95% CI 0.81-1.05; RD 7 fewer per 1000, 95% CI 16 fewer to 5 more). MRA use is associated with more hyperkalemia and worsening renal function, with no difference in withdrawal of the drug due to adverse events. compared to placebo. Conclusions: Among patients with HFnrEF, MRAs reduce HFH. Although MRAs increase the risk of hyperkalemia and worsening renal function, this does not lead to higher rates of drug discontinuation.
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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.