Why the study?
Although guidelines recommend early initiation of mineralocorticoid receptor antagonists in heart failure, practical real-world implementation is lacking, with common delays in initiation and suboptimum dosing.
This review emphasizes the need to bridge the gap between guideline recommendations and real-world practice regarding the early initiation and optimal dosing of MRAs 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.
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Banerjee et al. (2026) studied this question.
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