Mineralocorticoid receptor antagonists in patients with heart failure: current experience and future perspectives

Area of Science:

• Cardiology
• Pharmacology

Background:

• Current heart failure (HF) guidelines recommend mineralocorticoid receptor antagonists (MRAs) for patients with chronic HF and reduced left ventricular ejection fraction (HF-REF).
• MRAs are a cornerstone of HF-REF therapy, alongside ACE inhibitors/ARBs, beta-blockers, and diuretics.
• Despite a class I indication and proven benefits in reducing mortality and hospitalizations, MRA use in eligible patients remains suboptimal.

Purpose of the Study:

• To review the clinical evidence supporting the benefits of MRAs in HF-REF.
• To explore the mechanisms underlying MRA efficacy in heart failure.
• To promote increased utilization of MRAs in guideline-eligible HF-REF patients.

Main Methods:

• Review of clinical studies on MRAs in heart failure.
• Analysis of proposed mechanisms of action for MRAs in HF.
• Synthesis of guideline recommendations and clinical practice data.

Main Results:

• MRAs significantly reduce mortality and hospitalizations in HF-REF.
• Evidence supports MRAs as essential therapy for HF-REF.
• Suboptimal prescribing patterns persist despite clear benefits.

Conclusions:

• Increased MRA use in guideline-eligible HF-REF patients is warranted.
• Understanding MRA mechanisms can inform future therapeutic strategies.
• Further efforts are needed to bridge the gap between guidelines and clinical practice for MRAs in HF.