THE HEART FAILURE CASCADE AND THE ROLE OF MINERALOCORTICOID RECEPTOR ANTAGONISTS

Dr. Anish Desai* and Dr. Sunaina Anand

ABSTRACT

The guidelines on heart failure with reduced ejection fraction (HFrEF) have also recommended the use of Mineralocorticoid receptor antagonists (MRAs) despite treatment with an angiotensin-converting enzyme inhibitors (ACEI) and a beta-blocker in symptomatic patients with ejection fraction ≤35%, to reduce mortality and HF-related hospitalization. However, the use of MRAs is suboptimal. The current review aims to summarize the vast body of clinical evidence and mechanism behind the efficacy and safety of MRAs (Spironolactone, Eplerenone, Esaxerenone, Finerenone) in an attempt to increase their use in guideline eligible patients with HF. It will also provide the basis for understanding potential new opportunities for their use in patients with HF complicated with diabetes mellitus or renal impairment.

Keywords: Aldosterone, Guidelines, Heart failure, Ejection fraction, Mineralocorticoid receptor antagonists (MRAs).