SynthesisESC heart failure2026
Safety and efficacy of early initiation of mineralocorticoid receptor antagonist after an acute decompensated heart failure event or acute myocardial infarction with cardiac dysfunction: a meta-analysis of randomized clinical trials.
Synthesis in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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
2 citing papers in PubMed.
- Diuretics in Cardiovascular Disease: For How Long and at What Dose?Journal of cardiovascular development and disease · 2026Review
- The prognostic impact of beta blockers in ischemic heart failure: time for a paradigm shift?Heart failure reviews · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsTo conduct a meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of mineralocorticoid receptor antagonists (MRAs) initiation in patients with heart failure (HF) within a few weeks after a decompensation event or acute myocardial infarction with cardiac dysfunction.
methodsFour electronic databases were screened for eligible studies. Randomized controlled trials were included if they assessed MRA initiation either during an index hospitalization for HF or within 60 days following a first episode of HF decompensation or acute myocardial infarction with newly documented left ventricular dysfunction (i.e. <50%). When RCTs did not fulfil the eligibility criteria, subgroup analyses were examined and included if eligible. Efficacy endpoints were all-cause death, worsening HF, and length of hospital stay. Safety endpoints included worsening renal failure, hypokalaemia, and hyperkalaemia. A pre-specified subgroup analysis for efficacy endpoints was planned by clinical setting (acute ischaemic vs non-ischaemic HF). Six RCTs with 9770 patients were included.
resultsEarly MRA use was associated with a significantly lower risk of hypokalaemia [risk ratio (RR) 0.39, 95% confidence interval (CI) 0.26-0.58], without increasing the risk of worsening renal failure or hypotension, but with a modest increase in hyperkalaemia risk. Mineralocorticoid receptor antagonist initiation within 60 days after decompensation significantly reduced the risk of all-cause death (RR 0.87, 95% CI 0.79-0.95) and worsening HF (RR 0.81, 95% CI 0.72-0.91), with no effect on hospital length, when compared with usual care. These benefits were consistent in acute ischaemic vs non-ischaemic HF.
conclusionsEarly MRA initiation was associated with improved prognosis when compared with usual care, though accompanied by an increased risk of hyperkalaemia, warranting close follow-up after initiation. PROSPERO REGISTRATION NUMBER: CRD42025649719.
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