{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:20:44Z","timestamp":1788412844142,"version":"build-2803163510"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":370,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["523-2014-2336"],"award-info":[{"award-number":["523-2014-2336"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Heart Lung Foundation","award":["20150557"],"award-info":[{"award-number":["20150557"]}]},{"name":"Swedish Heart Lung Foundation","award":["20190310"],"award-info":[{"award-number":["20190310"]}]},{"DOI":"10.13039\/501100011727","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["20170112"],"award-info":[{"award-number":["20170112"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["20190525"],"award-info":[{"award-number":["20190525"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["523\u20102014\u20102336"],"award-info":[{"award-number":["523\u20102014\u20102336"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["20170112"],"award-info":[{"award-number":["20170112"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["20190525"],"award-info":[{"award-number":["20190525"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Mineralocorticoid receptor antagonists (MRA) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but are underused. Point prevalent use has been described, but the kinetics of discontinuation and the extent of reinitiation have not been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with HFrEF enrolled in the Swedish Heart Failure Registry between 2006 and 2021 were linked to the Prescribed Drug Register. The rate of discontinuation during the first year of treatment and reinitiation the year after discontinuation were estimated using the Kaplan\u2013Meier method. Multivariable Cox proportional hazards models were used to assess the predictors of discontinuation. Of 11\u2009474 MRA new users, 71% remained on therapy at 1 year. Baseline characteristics independently associated with discontinuation were: estimated glomerular filtration rate (eGFR) &amp;lt;30\u2009ml\/min\/1.73\u2009m2 (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.34\u20132.27), hyperkalaemia (HR 1.73, 95% CI 1.25\u20132.40), eGFR 30\u201360\u2009ml\/min\/1.73\u2009m2 (HR 1.51, 95% CI 1.37\u20131.66), age\u2009\u226580\u2009years (HR 1.26, 95% CI 1.10\u20131.43), enrolment as inpatient (HR 1.25, 95% CI 1.14\u20131.38), a diagnosis of atrial fibrillation (HR 1.24, 95% CI 1.10\u20131.39), living alone (HR 1.23, 95% CI 1.13\u20131.34), ischaemic heart disease (HR 1.20, 95% CI 1.09\u20131.31), anaemia (HR 1.17, 95% CI 1.07\u20131.29), diabetes mellitus (HR 1.15, 95% CI 1.04\u20131.27) and New York Heart Association class III\u2013IV (HR 1.13, 95% CI 1.02\u20131.24). Reinitiation within a year occurred in 46% of cases, mostly within 3\u2009months after discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with HFrEF initiated on MRA, 71% remained on therapy at 1 year. Discontinuation occurred early and was more common in patients with advanced kidney disease, hyperkalaemia, lack of follow-up in specialty care, more severe heart failure, comorbidities, and markers of sociodemographic frailty. Among those who discontinued, almost half reinitiated treatment the year following discontinuation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3523","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T23:30:14Z","timestamp":1732663814000},"page":"219-227","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Discontinuation and Reinitiation of Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Reduced Ejection Fraction"],"prefix":"10.1093","volume":"27","author":[{"given":"Laura","family":"Landucci","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Emergency and Reparative Medicine, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika Ljung","family":"Fax\u00e9n","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Perioperative Medicine and Intensive Care, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Benson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Dahlstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Health, Medicine and Caring Sciences, Linkoping University , Linkoping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"2026010913031286400_ejhf3523-bib-0001","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. 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