What is the clinical and cost effectiveness of adding a mineralocorticoid receptor antagonist to existing standard first line treatment in people with heart failure with reduced ejection fraction?
Four studies (reported in 13 papers) were included in the review: Eplerenone in Mild Patients Hospitalization and Survival Study , EMPHASIS-HF in Japanese patients (J- , Randomized Aldactone Evaluation Study (RALES)268, 350, 351 and Udelson 2010345. Evidence from these studies suggests that the addition of mineralocorticoid receptor antagonists to existing standard first line treatment in people with heart failure with reduced ejection fraction (HFREF) is clinically and cost effective, as it has been associated with improved all-cause mortality, quality of life, unplanned hospitalisation, improvement of NYHA class, and reduced adverse events such as renal function, gynaecomastia, hypotension, and hyperkalaemia.