Dose optimization and utilization trends of mineralocorticoid receptor antagonists in heart failure patients with reduced ejection fraction in Ethiopia

Nascent evidence-based guidelines advocate the use of Mineralocorticoid Receptor Antagonists (MRAs) in all heart failure patients with reduced ejection fraction (HFrEF) to abridge cardiovascular mortality and morbidity. This study assessed the utilization patterns and dose optimization of MRAs among patients with HFrEF at Dessie Comprehensive Specialized Hospital, Ethiopia, from March to August 2024. A cross-sectional analysis of 260 adult patients with confirmed HFrEF, who had been under follow-up for at least six months, was conducted. MRA use and dose optimization were evaluated according to 2022 American Heart Association (AHA) guidelines. Logistic regression identified factors associated with MRA use, with statistical significance set at p < 0.05. Among the 260 patients, 168 (64.6 %) were prescribed MRA, all receiving spironolactone. Of these, 119 (69.1 %) used it to reduce cardiovascular mortality, while 30.9 % used it for its potassium-sparing effect. However, only 38 (22.6 %) patients received the optimal dose, with a mean daily dose of 22.3 mg. MRAs underuse was observed in 83 (31.9 %) patients. Factors positively associated with MRA use included female sex (AOR = 2.79, 95 % CI: 1.33–5.85), NYHA class III (AOR = 4.99, 95 % CI: 1.71–14.61), diuretic use (AOR = 7.58, 95 % CI: 3.02–19.05), and taking five or more medications (AOR = 3.87, 95 % CI: 1.46–10.29). Conversely, negative associations were found with secondary prevention agents (AOR = 0.04, 95 % CI: 0.01–0.22) and a baseline serum potassium level of 5–5.5 meq/L (AOR = 0.20, 95 % CI: 0.08–0.53). While MRA use is common, optimal dosing remains suboptimal. Clinicians should adhere to guideline recommendations to ensure optimal dosing and maximize clinical benefits. • First study in Ethiopia to assess Mineralocorticoid Receptor Antagonist (MRA) use and dose optimization in HFrEF patients. • While over 64% of HFrEF patients in Ethiopia are prescribed MRAs, only 22.6% receive the optimal dose. • Factors such as female sex, NYHA class III, diuretic use, and polypharmacy are linked to better MRA utilization. • The use of secondary prevention agents and higher baseline serum potassium levels are associated with poorer MRA use.