{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:41:23Z","timestamp":1768552883019,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,8,14]],"date-time":"2018-08-14T00:00:00Z","timestamp":1534204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Heart Foundation of Northern Sweden"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Previous studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (<jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>) in heart failure with reduced ejection fraction (<jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>). This study aimed to investigate why <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> is not used to full extent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A complete community\u2010based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2029 patients, 812 had <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content> \u226440%. Five hundred and fifty\u2010three patients (68%) tried <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> at some point but 184 of these (33%) discontinued therapy. There were 259 patients that never tried <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> with 177 with a listed explanation or contraindication. Eighty\u2010two patients, 10% of the total <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content> population, had no clear contraindications. They were older and had less <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content> hospitalizations compared to patients on <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) and 32% did not have any follow\u2010up at the cardiology clinic. Contraindications to <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> were renal dysfunction (93 patients), hypotension (28 patients), and hyperkalemia (25 patients). Only six patients had hyperkalemia without renal dysfunction. Of the patients with renal dysfunction, 66 (72%) had <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content> &gt;30\u00a0mL\/min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The reasons why <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content> are underutilized were mainly because of contraindications. However, the data suggest that physicians are overly cautious about moderately reduced kidney function. There seems to be a 10%\u201018% avoidable undertreatment with <jats:styled-content style=\"fixed-case\">MRA<\/jats:styled-content>, especially for elderly patients that are admitted to the hospital for other reasons than heart failure. This suggests that patients with heart failure would benefit from routine follow\u2010up at a cardiology clinic.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1755-5922.12459","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T19:00:08Z","timestamp":1531940408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Obstacles to mineralocorticoid receptor antagonists in a community\u2010based heart failure population"],"prefix":"10.1111","volume":"36","author":[{"given":"Anna","family":"Jonsson","sequence":"first","affiliation":[{"name":"Department of Public Health and Clinical Medicine Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6785-2895","authenticated-orcid":false,"given":"Helena","family":"Norberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine 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