Title:Effect of Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction and with Reduced Ejection Fraction - A Narrative Review
Volume: 20
Issue: 1
Author(s): Adriana Mares, Tayana Rodriguez, Abhizith Deoker, Angelica Lehker and Debabrata Mukherjee*
Affiliation:
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas 79905, USA
Keywords:
Heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, mineralocorticoid receptor antagonists, heart failure, left ventricular ejection fraction, readmission.
Abstract:
Background: Heart failure is a major cause of morbidity and mortality globally. By the
end of this decade, ~8 million Americans will have heart failure with an expenditure of $69.8 billion.
Objective: In this narrative review, we evaluate the benefits, potential risks and the role of Mineralocorticoid
Receptor Antagonists (MRAs) in the management of both Heart Failure with Preserved
Ejection Fraction (HFpEF) and Heart Failure with Reduced Ejection Fraction (HFrEF).
Methods: We performed a comprehensive literature review to assess the available evidence on the
role of MRAs in heart failure using the online databases (PubMed, Embase, Scopus, CINAHL and
Google Scholar).
Results: Clinical evidence shows that MRAs such as spironolactone and eplerenone reduce mortality
and readmissions for patients with HFrEF compared with placebo. Furthermore, one trial reported
that MRAs reduce heart failure hospitalization in patients with HFpEF. The American College
of Cardiology/American Heart Association Guidelines strongly recommend using MRA in patients
with reduced Left Ventricular Ejection Fraction (LVEF) with Class II-IV symptoms, estimated
glomerular filtration rate >30 ml/min/1.73 m2, and absence of hyperkalemia. Despite this, MRAs
are underutilized in the management of heart failure.
Conclusions: MRAs improve outcomes in patients with both HFpEF and HFrEF but remain underutilized.
