{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T20:00:31Z","timestamp":1787083231013,"version":"build-2736575974"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>To conduct a meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of mineralocorticoid receptor antagonists (MRAs) initiation in patients with heart failure (HF) within a few weeks after a decompensation event or acute myocardial infarction with cardiac dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four electronic databases were screened for eligible studies. Randomized controlled trials were included if they assessed MRA initiation either during an index hospitalization for HF or within 60 days following a first episode of HF decompensation or acute myocardial infarction with newly documented left ventricular dysfunction (i.e. &amp;lt;50%). When RCTs did not fulfil the eligibility criteria, subgroup analyses were examined and included if eligible. Efficacy endpoints were all-cause death, worsening HF, and length of hospital stay. Safety endpoints included worsening renal failure, hypokalaemia, and hyperkalaemia. A pre-specified subgroup analysis for efficacy endpoints was planned by clinical setting (acute ischaemic vs non-ischaemic HF). Six RCTs with 9770 patients were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Early MRA use was associated with a significantly lower risk of hypokalaemia [risk ratio (RR) 0.39, 95% confidence interval (CI) 0.26\u20130.58], without increasing the risk of worsening renal failure or hypotension, but with a modest increase in hyperkalaemia risk. Mineralocorticoid receptor antagonist initiation within 60 days after decompensation significantly reduced the risk of all-cause death (RR 0.87, 95% CI 0.79\u20130.95) and worsening HF (RR 0.81, 95% CI 0.72\u20130.91), with no effect on hospital length, when compared with usual care. These benefits were consistent in acute ischaemic vs non-ischaemic HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early MRA initiation was associated with improved prognosis when compared with usual care, though accompanied by an increased risk of hyperkalaemia, warranting close follow-up after initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO Registration number<\/jats:title>\n                    <jats:p>CRD42025649719<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag018","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:26:30Z","timestamp":1771331190000},"source":"Crossref","is-referenced-by-count":3,"title":["Safety and efficacy of early initiation of mineralocorticoid receptor antagonist after an acute decompensated heart failure event or acute myocardial infarction with cardiac dysfunction: a meta-analysis of randomized clinical trials"],"prefix":"10.1093","volume":"13","author":[{"given":"Renzo","family":"Laborante","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato Antonio","family":"Paglianiti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Elia","sequence":"additional","affiliation":[{"name":"Thoracic-Cardiovascular Department, Azienda Ospedaliero-Universitaria Maggiore della Carit\u00e0 , Novara ,","place":["Italy"]},{"name":"Department of Translational Medicine, University of Eastern Piedmont , Novara 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