What factors are associated with the underuse of mineralocorticoid receptor antagonists in patients with HFrEF?
MRA underuse in HFrEF is driven by impaired renal function (even when not contraindicated), non-specialist care, and milder disease, highlighting specific targets for quality improvement.
Mineralocorticoid receptor antagonists remain underused in HFrEF. Their use does not decrease with elevated potassium but does with impaired renal function, even in the creatinine clearance 30-59.9 mL/min range where MRAs are not contraindicated. MRA underuse may be further related to non-specialist care, milder HF and no use of other HF therapy.
Savarese et al. (Mon,) studied this question.