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Effect of Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction and with Reduced Ejection Fraction - A Narrative Review.

BACKGROUND
Heart failure is a major cause of morbidity and mortality globally. By 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 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 has reported that MRAs minimize 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.