Early Initiation and Dose Optimization of Mineralocorticoid Receptor Antagonists in Heart Failure

Guidelines recommend that the foundation four guideline-directed medical therapy (GDMT), which includes mineralocorticoid receptor antagonists (MRAs), should be initiated early in the treatment paradigm of heart failure due to mortality benefits and reduction in hospitalization for heart failure. However, the practical implementation of these guidelines in the real-world clinical scenario is lacking. Delay in initiating MRA is common, and patients often do not receive the optimum dose of MRA. The clinical considerations and guideline recommendations for early initiation and optimum dosing of MRA in HF can form the scientific basis for improving the correct usage of MRA in HF in real-world settings.