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Publications

Journal Article Review Epublish

PubMed: 42368482 DOI: 10.15420/cfr.2025.57

Mineralocorticoid Receptor Antagonist Use in Contemporary Heart Failure Care.

Card Fail Rev 12:e15

Authors: Jolie Bruno, Alexandre Mebazaa, Lídia Zytynski Moura, Jelena Čelutkienė, Andrew Sindone, Giuseppe Rosano

Affiliations

  • INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT) Paris, France.
  • Université de Paris Cité Paris, France.
  • Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis et Lariboisière, AP-HP Paris, France.
  • Department of Cardiology, Inselspital, Bern University Hospital Bern, Switzerland.
  • Department of Internal Medicine, Advanced Cardiovascular Disease and Heart Failure, Pontifícia Universidade Católica do Paraná Curitiba, Brazil.
  • Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Medical Faculty, Vilnius University Vilnius, Lithuania.
  • Centre of Innovative Medicine Vilnius, Lithuania.
  • Department of Cardiology and Cardiac Rehabilitation, Concord Hospital, University of Sydney Sydney, Australia.
  • Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome Rome, Italy.
  • Department of Cardiology, IRCCS San Raffaele Roma Rome, Italy.

Abstract

Heart failure (HF) continues to challenge clinicians worldwide, not only because of its high morbidity and mortality, but also due to the persistent difficulty in translating therapeutic advances into routine care. Despite the availability of effective treatments, data show striking gaps in the optimal use of guideline-directed medical therapy. Among the four pillars of guideline-directed medical therapy, mineralocorticoid receptor antagonists (MRAs) remain the least prescribed. This underuse is concerning considering the evidence demonstrating consistent benefits of MRAs across different HF phenotypes. In this review, we revisit the role of MRAs across the spectrum of HF. We summarise the supporting evidence, discuss their mechanisms of action and provide practical guidance on patient eligibility and initiation strategies. In addition, we address common barriers that often limit their use. By combining mechanistic insights, trial evidence and pragmatic recommendations, this review aims to facilitate broader and earlier use of MRAs, thereby helping to close a major gap in the implementation of evidence-based HF care.

MeSH

Heart Failure, Heart, Cardiac Rehabilitation, Receptors, Mineralocorticoid, Therapeutics, Mineralocorticoids, Mineralocorticoid Receptor Antagonists, Prognosis