{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:48:50Z","timestamp":1792021730357,"version":"4.4.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR\u201015\u2010RHU\u20100004"],"award-info":[{"award-number":["ANR\u201015\u2010RHU\u20100004"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Despite landmark heart failure (HF) with reduced ejection fraction (HFrEF) trials showing effect of mineralocorticoid receptor antagonists (MRA) on the risk of death and HF hospitalization, it has been suggested that MRAs are underutilized or frequently withdrawn. This study sought to identify temporal trends in the initiation of MRAs and the subsequent risk of withdrawal and adherence of MRAs in HF patients treated with a renin\u2013angiotensin system inhibitor and a beta\u2010blocker in Denmark from 2003\u20132017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>From nationwide registries, we identified patients receiving a diagnosis of HF. Use of MRA was identified by at least one prescription within 6\u2009months after the diagnosis. The absolute risk of withdrawal with treatment was assessed with cumulative incidence, accounting for the competing risk of death. To estimate adherence, we calculated the proportion of days covered. We included 51\u2009512 patients with incident HF. During the study period, 20\u2009779 (40.3%) patients initiated MRA therapy. The incidence of withdrawal of MRA was 49.2% throughout the study period; 48.0% of the HF patients were adherent to the treatment. Among patients withdrawing treatment with MRA, the cumulative incidence of reinitiating was 36.6%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a nationwide cohort of patients with HF, approximately half of the patients received MRA as third\u2010line therapy within the first 6\u2009months after diagnosis and approximately half of these withdrew MRA within 5\u2009years. These findings warrant an increasing focus on retention to MRA treatment in a real\u2010life setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2418","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T17:30:11Z","timestamp":1640885411000},"page":"539-547","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Temporal trends in initiation of mineralocorticoid receptor antagonists and risk of subsequent withdrawal in patients with heart failure: a nationwide study in\n                    <scp>Denmark<\/scp>\n                    from 2003\u20132017"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9564-6231","authenticated-orcid":false,"given":"Deewa","family":"Zahir","sequence":"first","affiliation":[{"name":"Department of Cardiology Copenhagen University Hospital  Hellerup Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Bonde","sequence":"additional","affiliation":[{"name":"Department of Cardiology Copenhagen University Hospital  Hellerup Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2127-3556","authenticated-orcid":false,"given":"Christian","family":"Madelaire","sequence":"additional","affiliation":[{"name":"Department of Cardiology Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4838-2031","authenticated-orcid":false,"given":"Morten","family":"Malmborg","sequence":"additional","affiliation":[{"name":"The Danish Heart Foundation  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-4144","authenticated-orcid":false,"given":"Jawad H.","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rigshospitalet, Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2048-4167","authenticated-orcid":false,"given":"Emil","family":"Fosbol","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rigshospitalet, Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0548-402X","authenticated-orcid":false,"given":"Gunnar","family":"Gislason","sequence":"additional","affiliation":[{"name":"Department of Cardiology Copenhagen University Hospital  Hellerup Denmark"},{"name":"The Danish Heart Foundation  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"The National Institute of Public Health University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Research and Cardiology Nordsj\u00e6llands Hospital  Hiller\u00f8d Denmark"},{"name":"Department of Cardiology Aalborg University Hospital  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Cardiology Copenhagen University Hospital  Hellerup Denmark"},{"name":"Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center Boston University School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d'Investigations Cliniques\u2010Plurith\u00e9matique 1433, French\u2010Clinical Research Infrastructure Network (F\u2010CRIN) INI\u2010CRCT (Cardiovascular and Renal Clinical Trialists)  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":false,"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-1466","authenticated-orcid":false,"given":"Lars","family":"Kober","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rigshospitalet, Copenhagen University Hospital  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Schou","sequence":"additional","affiliation":[{"name":"Department of Cardiology Copenhagen University Hospital  Hellerup 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