Fears of hyperkalemia and worsening renal function drive the underuse of guideline-directed medical therapies in HFrEF patients.
ARNI with spironolactone was associated with lower severe hyperkalemia risk in HF; extends observational data but leaves practice change to prospective trials.
Patients with heart failure (HF) and reduced ejection fraction (HFREF) are at increased risk of death and hospitalizations for HF. Numerous registries have reported a large and persistent gap between real-life practice in the use of life-saving evidence-based therapies, such as renin angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs), and recommended practices in international guidelines. The fears of inducing hyperkalemia and/or worsening renal function are the main triggers of this underuse.
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Pitt et al. (2017) studied this question.
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