Related Experiment Videos

Mineralocorticoid Receptor Antagonist Use in Contemporary Heart Failure Care

Jolie Bruno1,2,3,4, Alexandre Mebazaa1,2,3, Lídia Zytynski Moura5

  • 1INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT) Paris, France.

Cardiac Failure Review
|June 29, 2026
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) are underused in heart failure (HF) despite proven benefits. This review provides evidence and guidance to increase MRA use for better HF management.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure (HF) presents significant global health challenges.
  • Optimal use of guideline-directed medical therapy (GDMT) in HF remains suboptimal.
  • Mineralocorticoid receptor antagonists (MRAs) are the least prescribed among the four pillars of HF GDMT.

Purpose of the Study:

  • To review the role of MRAs across the spectrum of heart failure.
  • To summarize supporting evidence, mechanisms of action, and practical guidance for MRA use.
  • To address barriers limiting MRA prescription and facilitate broader adoption.

Main Methods:

  • Literature review of clinical trials and mechanistic studies on MRAs in HF.
  • Analysis of current guidelines and prescribing data.
  • Synthesis of evidence to provide practical recommendations for MRA initiation.

Main Results:

  • MRAs demonstrate consistent benefits across various HF phenotypes.
  • Significant gaps exist in the optimal utilization of MRAs in routine clinical practice.
  • Barriers to MRA use include concerns about side effects, cost, and physician inertia.

Conclusions:

  • Increased and earlier use of MRAs can improve heart failure outcomes.
  • Addressing prescribing barriers is crucial for implementing evidence-based HF care.
  • This review aims to equip clinicians with knowledge to optimize MRA therapy.

Keywords:
Mineralocorticoid receptor antagonistacute heart failurecardiac rehabilitationchronic heart failureheart failureprognosistherapy

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.