European Journal of Heart Failure International Expert Position Paper—Utilization, optimization, and clinical benefits of steroidal mineralocorticoid receptor antagonists in heart failure with a reduced ejection fraction

作者：Michael Böhm, J. Abdullakutty, J Bauersachs, Udo Bavendiek, Antoni Bayés‐Genís, Kuntal Bhattacharyya, Jan Biegus, Biykem Bozkurt, Javed Butler, J Ezhilan, Joao P Ferreira, Nicolas Girerd, Rahul Gupta, Jagdish Hiremath, Pardeep Jhund, Thorsten Kessler, Dilip Kumar, Philipp Markwirth, Nikolaus Marx, Teresa McDonagh, Girish Navsundi, Arindam Pande, Mark Petrie, Piotr Ponikowski, Amina Rakisheva, Giuseppe Rosano, N Sato, Gianluigi Savarese, Kamal Sharma, K Sliwa, B Somaraju, Samuel Sossalla, Stefan Störk, Mert Tokcan, K. Tsioufis, Yuhui Zhang, Lei Zhang, Shelley Zieroth, Faı̈ez Zannad · 发表于：European Journal of Heart Failure · 年份：2026 · DOI：10.1093/ejhf/xuag106 · 被引用次数：1 · 研究领域：Hormonal Regulation and Hypertension、Adrenal Hormones and Disorders、Heart Failure Treatment and Management

Heart failure with reduced ejection fraction (HFrEF) imposes a significant clinical burden on patients and a major economic burden on healthcare systems. In HFrEF, mineralocorticoid receptor antagonists (MRAs) constitute a cornerstone of guideline-directed medical therapy (GDMT) reducing both mortality and hospitalisation. Their use in practice remains suboptimal, largely because of physicians' concerns about adverse events, particularly hyperkalaemia, which may deprive eligible patients of benefit. Only the steroidal MRAs spironolactone and eplerenone are approved for HFrEF, and this consensus document is restricted to these agents. We summarise contemporary evidence across multiple domains related to MRA therapy in HFrEF, including pharmacoepidemiology, the role of biomarkers in predicting outcomes and response to MRA, the pathological role of aldosterone and the pharmacology and clinical efficacy of steroidal MRAs. Practical, evidence-based guidance is provided on the prevention and management of hyperkalaemia, the timing of MRA initiation, and strategies to overcome barriers to MRA use. The positioning of MRAs in current guidelines is outlined to reinforce their central role in HFrEF. The process of consensus finding was started in April 2025 with a core group by online conference. We searched PubMed with the terms "MRA, eplerenone and heart failure with reduced ejection fraction". Articles published in English with no date restriction were considered. The final manuscrip...