Key result
Steroidal mineralocorticoid receptor antagonists remain among the least prescribed guideline-directed therapies for heart failure due to reported risks like worsening kidney function and hyperkalemia.
Why the study?
Steroidal mineralocorticoid receptor antagonists are among the least prescribed guideline-directed medical therapies in heart failure across the ejection fraction spectrum, possibly due to concerns about kidney function and cardiovascular outcomes, especially in patients with chronic kidney disease.
Observational
Answers are grounded in this paper and cite their sources.
Low sMRA initiation rates in new HF signal persistent implementation gaps; leaves open whether targeted CKM interventions can safely improve uptake.
Heart failure (HF) is increasingly recognized within the broader context of cardiovascular-kidney-metabolic (CKM) syndrome, characterized by the interrelationship of excess adiposity, metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease.1 The ability to initiate and maintain guideline-directed medical therapy (GDMT) may be particularly affected by the intersection of CKD and HF. Steroidal mineralocorticoid receptor antagonist (sMRA) remains among the least prescribed GDMT classes across the ejection fraction (EF) spectrum, possibly due to reported risks of worsening kidney function, hyperkalemia, and failure to demonstrate improvements in cardiovascular outcomes, especially among those with CKD.
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Fonarow et al. (2026) conducted an observational in Heart failure. Steroidal mineralocorticoid receptor antagonist (sMRA) was evaluated. Steroidal mineralocorticoid receptor antagonists remain among the least prescribed guideline-directed therapies for heart failure due to reported risks like worsening kidney function and hyperkalemia.
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