What are the benefits and risks of Mineralocorticoid Receptor Antagonists (MRA) therapy for people with Heart Failure with Reduced Ejection Fraction (HFREF)?
Studies published since 2010 have investigated whether MRA therapy would result in clinical benefits in the general population of patients with heart failure with reduced ejection fraction (HFREF). However, MRAs can also induce adverse events such as electrolyte disturbances (particularly hyperkalemia) and worsening renal dysfunction resulting in increased morbidity and hospitalisations. In addition, the committee agreed that cross-over studies should be excluded to ensure that potential carryover effects are not confounding the outcome. The prospective randomised registry-based trial in HFPEF, the Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT), is due to start recruiting and could help answer the questions in this field.