{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:55:06Z","timestamp":1792234506099,"version":"4.4.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure (HF) continues to portend significant morbidity and mortality within the USA. Data regarding the efficacy of mineralocorticoid receptor antagonists (MRAs) in HF with preserved ejection fraction (HFpEF) remains unclear. Finerenone, a non-steroidal MRA, has demonstrated reduction in hospitalizations in this population. However, the comparative efficacy of different MRA classes in these patients remains elusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a retrospective observational cohort study using the TriNetX research network. We applied 1:1 propensity score matching (PSM) to compare patients with HFpEF initiated on finerenone vs. spironolactone. We examined 1-year risks of HF exacerbation, acute kidney injury (AKI), electrolyte derangements, and cardiovascular outcomes. We identified 254,417 patients with HFpEF and MRA use. After PSM, each cohort contained 491 patients. Analysis revealed that finerenone use was associated with a significantly lower risk of HF exacerbation (hazard ratio [HR] = 0.63 [95% confidence interval [CI]: 0.54, 0.74], P &amp;lt; 0.001), all-cause mortality (HR = 0.38 [95% CI: 0.23, 0.64], P &amp;lt; 0.001), and hypokalaemia (HR = 0.58 [95% CI: 0.40, 0.85], P = 0.001). The aforementioned results, along with a reduction in AKI risk, were statistically significant after stratified subgroup analysis by diabetes mellitus and chronic kidney disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large real-world HFpEF cohort, finerenone use was associated with lower risks of HF exacerbation and all-cause mortality compared with spironolactone. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcag014","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:45:54Z","timestamp":1769690754000},"page":"718-730","source":"Crossref","is-referenced-by-count":4,"title":["Steroidal vs. non-steroidal mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction: a propensity-matched multi-network nationwide cohort study"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8867-600X","authenticated-orcid":false,"given":"Talal","family":"Almas","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH 44106 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Shelig","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine , Huntington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al-Hindawi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Creighton University School of Medicine , Omaha, NE ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kannu","family":"Bansal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Saint Vincent Hospital , Worcester, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Absam","family":"Akbar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic Foundation , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal Naveed","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rashid Latif Medical College , Lahore ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Ismayl","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasem","family":"Burahmah","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization (KIMS), Ministry of Health , Kuwait City, P.O. Box 1793, Safat 13018, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah W","family":"AlHamlan","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization (KIMS), Ministry of Health , Kuwait City, P.O. Box 1793, Safat 13018, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"AlMojil","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization (KIMS), Ministry of Health , Kuwait City, P.O. Box 1793, Safat 13018, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Almukhaizeem","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization (KIMS), Ministry of Health , Kuwait City, P.O. Box 1793, Safat 13018, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam Nadeem","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alansari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Galway University Hospital , Galway ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Zacharias","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Ramani","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3386-7650","authenticated-orcid":false,"given":"Daniel I","family":"Simon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R","family":"Desai","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Joseph","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026081102574954400_qcag014-B1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/nrcardio.2017.65","article-title":"Epidemiology of heart failure with preserved ejection fraction","volume":"14","author":"Dunlay","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"2026081102574954400_qcag014-B2","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/eurjhf\/hft062","article-title":"How do patients with heart failure with preserved ejection fraction die?","volume":"15","author":"Chan","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026081102574954400_qcag014-B3","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1161\/CIRCHEARTFAILURE.110.957480","article-title":"A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction","volume":"4","author":"Lee","year":"2011","journal-title":"Circ Heart Fail"},{"key":"2026081102574954400_qcag014-B4","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"2026081102574954400_qcag014-B5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ccl.2013.09.002","article-title":"The renin-angiotensin-aldosterone system and heart failure","volume":"32","author":"Sayer","year":"2014","journal-title":"Cardiol Clin"},{"key":"2026081102574954400_qcag014-B6","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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