{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:58:46Z","timestamp":1771826326495,"version":"3.50.1"},"reference-count":49,"publisher":"Jaypee Brothers Medical Publishing","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.59556\/japi.74.1298","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:02:05Z","timestamp":1771822925000},"page":"32-35","source":"Crossref","is-referenced-by-count":0,"title":["Tackling Therapeutic Inertia on Mineralocorticoid Receptor Antagonist Adoption in Heart Failure"],"prefix":"10.59556","volume":"74","author":[{"given":"Aparna","family":"Jaswal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tapan","family":"Ghose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Animesh","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay K","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirmalya","family":"Chakravarty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjan","family":"Roy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anasuya","family":"D S","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhiren C","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Sankhla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Anitha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilip","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Febin","family":"Francis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amarnath","family":"Sugumaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senthilnathan","family":"Mohanasundaram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2914","reference":[{"key":"key20260223050159_B1","article-title":"Clinical inertia and outpatient medical errors.","author":"O'Connor","year":"2005.","journal-title":"Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Advances in Patient Safety. Agency for Healthcare Research and Quality (US);"},{"issue":"(2):","key":"key20260223050159_B2","doi-asserted-by":"crossref","first-page":"243\u2013","DOI":"10.1007\/s40119-024-00367-4","article-title":"Management of heart failure in a resource-limited setting: expert opinion from India.","volume":"13","author":"Jain","year":"2024;","journal-title":"Cardiol Ther"},{"issue":"(6):","key":"key20260223050159_B3","doi-asserted-by":"crossref","first-page":"1359\u2013","DOI":"10.1007\/s10741-020-09979-z","article-title":"Clinical inertia in the treatment of heart failure: a major issue to tackle.","volume":"26","author":"Verhestraeten","year":"2021;","journal-title":"Heart Fail Rev"},{"issue":"(3):","key":"key20260223050159_B4","doi-asserted-by":"crossref","first-page":"147\u2013","DOI":"10.1016\/j.ihj.2024.04.004","article-title":"Heart failure, the global pandemic: a call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023.","volume":"76","author":"Harikrishnan","year":"2024;","journal-title":"Indian Heart J"},{"issue":"(10):","key":"key20260223050159_B5","doi-asserted-by":"crossref","first-page":"709\u2013","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.","volume":"341","author":"Pitt","year":"1999;","journal-title":"N Engl J Med"},{"issue":"(14):","key":"key20260223050159_B6","doi-asserted-by":"crossref","first-page":"1309\u2013","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.","volume":"348","author":"Pitt","year":"2003;","journal-title":"N Engl J Med"},{"issue":"(1):","key":"key20260223050159_B7","doi-asserted-by":"crossref","first-page":"11\u2013","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms.","volume":"364","author":"Zannad","year":"2011;","journal-title":"N Engl J Med"},{"issue":"(10458):","key":"key20260223050159_B8","doi-asserted-by":"crossref","first-page":"1119\u2013","DOI":"10.1016\/S0140-6736(24)01733-1","article-title":"Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis.","volume":"404","author":"Jhund","year":"2024;","journal-title":"Lancet"},{"issue":"(3):","key":"key20260223050159_B9","doi-asserted-by":"crossref","first-page":"e002493.","DOI":"10.1161\/JAHA.115.002493","article-title":"Barriers to adoption of mineralocorticoid receptor antagonists in patients with heart failure: a mixed-methods study.","volume":"5","author":"Dev","year":"2016;","journal-title":"J Am Heart Assoc"},{"issue":"(1):","key":"key20260223050159_B10","doi-asserted-by":"crossref","first-page":"74.","DOI":"10.5334\/gh.1355","article-title":"Use of guideline-recommended heart failure drugs in high-, middle-, and low-income countries: a systematic review and meta-analysis.","volume":"19","author":"Satheesh","year":"2024;","journal-title":"Glob Heart"},{"issue":"(10244):","key":"key20260223050159_B11","doi-asserted-by":"crossref","first-page":"121\u2013","DOI":"10.1016\/S0140-6736(20)30748-0","article-title":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials.","volume":"396","author":"Vaduganathan","year":"2020;","journal-title":"Lancet"},{"issue":"(10367):","key":"key20260223050159_B12","doi-asserted-by":"crossref","first-page":"1938\u2013","DOI":"10.1016\/S0140-6736(22)02076-1","article-title":"Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial.","volume":"400","author":"Mebazaa","year":"2022;","journal-title":"Lancet"},{"issue":"(11):","key":"key20260223050159_B13","doi-asserted-by":"crossref","first-page":"1579\u2013","DOI":"10.1016\/j.jchf.2023.06.022","article-title":"Clinical inertia among outpatients with heart failure.","volume":"11","author":"Swat","year":"2023;","journal-title":"JACC Heart Fail"},{"issue":"(15):","key":"key20260223050159_B14","doi-asserted-by":"crossref","first-page":"1444\u2013","DOI":"10.1016\/j.jacc.2023.12.024","article-title":"2024 ACC expert consensus decision pathway for treatment of heart failure with reduced ejection fraction.","volume":"83","author":"Maddox","year":"2024;","journal-title":"J Am Coll Cardiol"},{"issue":"(3):","key":"key20260223050159_B15","doi-asserted-by":"crossref","first-page":"180\u2013","DOI":"10.1093\/ehjcvp\/pvy015","article-title":"Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology.","volume":"4","author":"Rosano","year":"2018;","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"issue":"(6):","key":"key20260223050159_B16","doi-asserted-by":"crossref","first-page":"311\u2013","DOI":"10.1111\/nep.14281","article-title":"Consensus statement on the management of hyperkalaemia\u2014an Asia-Pacific perspective.","volume":"29","author":"Yap","year":"2024;","journal-title":"Nephrology"},{"issue":"(9):","key":"key20260223050159_B17","first-page":"e45241.","article-title":"Impact of mineralocorticoid receptor antagonists in the treatment of heart failure: targeting the heart failure cascade.","volume":"15","author":"Jadhav","year":"2023;","journal-title":"Cureus"},{"key":"key20260223050159_B18","unstructured":"Scott JH, Menouar MA, Dunn RJ. Physiology, aldosterone. StatPearls Publishing; 2025. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470339\/ [Last accessed December, 2025]."},{"issue":"(6):","key":"key20260223050159_B19","doi-asserted-by":"crossref","first-page":"1227\u2013","DOI":"10.1161\/01.HYP.0000193502.77417.17","article-title":"Mechanisms of mineralocorticoid action.","volume":"46","author":"Fuller","year":"2005;","journal-title":"Hypertension"},{"key":"key20260223050159_B20","doi-asserted-by":"crossref","first-page":"99\u2013","DOI":"10.1016\/j.ahj.2017.03.011","article-title":"True rate of mineralocorticoid receptor antagonists-related hyperkalemia in placebo-controlled trials: a meta-analysis.","volume":"188:","author":"Vukadinovi\u0107","year":"2017;","journal-title":"Am Heart J"},{"issue":"(5):","key":"key20260223050159_B21","doi-asserted-by":"crossref","first-page":"659\u2013","DOI":"10.1517\/14740338.2016.1163335","article-title":"The safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure.","volume":"15","author":"Pitt","year":"2016;","journal-title":"Expert Opin Drug Saf"},{"issue":"(4):","key":"key20260223050159_B22","doi-asserted-by":"crossref","first-page":"751\u2013","DOI":"10.1002\/ejhf.1640","article-title":"Potassium abnormalities in patients with heart failure from 11 Asian regions: insights from the ASIAN-HF registry.","volume":"22","author":"Beusekamp","year":"2020;","journal-title":"Eur J Heart Fail"},{"issue":"(9):","key":"key20260223050159_B23","doi-asserted-by":"crossref","first-page":"e1008\u2013","DOI":"10.1016\/S2214-109X(18)30306-1","article-title":"Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study.","volume":"6","author":"Teng","year":"2018;","journal-title":"Lancet Glob Health"},{"issue":"(9):","key":"key20260223050159_B24","doi-asserted-by":"crossref","first-page":"1326\u2013","DOI":"10.1002\/ejhf.1182","article-title":"Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11,215 patients from the Swedish Heart Failure Registry.","volume":"20","author":"Savarese","year":"2018;","journal-title":"Eur J Heart Fail"},{"issue":"(4):","key":"key20260223050159_B25","doi-asserted-by":"crossref","first-page":"573\u2013","DOI":"10.1161\/CIRCHEARTFAILURE.114.001104","article-title":"Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist.","volume":"7","author":"Vardeny","year":"2014;","journal-title":"Circ Heart Fail"},{"issue":"(10):","key":"key20260223050159_B26","doi-asserted-by":"crossref","first-page":"1698\u2013","DOI":"10.1002\/ejhf.2287","article-title":"Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care.","volume":"23","author":"Trevisan","year":"2021;","journal-title":"Eur J Heart Fail"},{"issue":"(8):","key":"key20260223050159_B27","first-page":"902\u2013","article-title":"Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the Randomized Aldactone Evaluation Study [RALES]).","volume":"78","author":"The RALES investigators.","year":"1996;","journal-title":"Am J Cardiol"},{"issue":"(9):","key":"key20260223050159_B28","doi-asserted-by":"crossref","first-page":"1467\u2013","DOI":"10.1002\/ejhf.2612","article-title":"An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum.","volume":"24","author":"Burton","year":"2022;","journal-title":"Eur J Heart Fail"},{"issue":"(41):","key":"key20260223050159_B29","doi-asserted-by":"crossref","first-page":"4362\u2013","DOI":"10.1093\/eurheartj\/ehac401","article-title":"Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.","volume":"43","author":"Butler","year":"2022;","journal-title":"Eur Heart J"},{"issue":"(3):","key":"key20260223050159_B30","doi-asserted-by":"crossref","first-page":"211\u2013","DOI":"10.1056\/NEJMoa1410853","article-title":"Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors.","volume":"372","author":"Weir","year":"2015;","journal-title":"N Engl J Med"},{"issue":"(21):","key":"key20260223050159_B31","doi-asserted-by":"crossref","first-page":"2223\u2013","DOI":"10.1001\/jama.2014.15688","article-title":"Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial.","volume":"312","author":"Kosiborod","year":"2014;","journal-title":"JAMA"},{"issue":"(1):","key":"key20260223050159_B32","doi-asserted-by":"crossref","first-page":"133\u2013","DOI":"10.1159\/000543385","article-title":"EMCREG-International multidisciplinary consensus panel on management of hyperkalemia in chronic kidney disease and heart failure.","volume":"15","author":"Kreitzer","year":"2025;","journal-title":"Cardiorenal Med"},{"issue":"(1):","key":"key20260223050159_B33","doi-asserted-by":"crossref","first-page":"42\u2013","DOI":"10.1016\/j.kint.2019.09.018","article-title":"Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.","volume":"97","author":"Clase","year":"2020;","journal-title":"Kidney Int"},{"issue":"(1):","key":"key20260223050159_B34","first-page":"4\u2013","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.","volume":"24","author":"McDonagh","year":"2022;","journal-title":"Eur J Heart Fail"},{"key":"key20260223050159_B35","doi-asserted-by":"crossref","first-page":"227\u2013","DOI":"10.2147\/IJNRD.S476344","article-title":"Management of hyperkalemia: expert consensus from Kuwait\u2014a modified Delphi approach.","volume":"17:","author":"AlSahow","year":"2024;","journal-title":"Int J Nephrol Renovasc Dis"},{"issue":"(2):","key":"key20260223050159_B36","doi-asserted-by":"crossref","first-page":"141\u2013","DOI":"10.1016\/j.gheart.2013.05.002","article-title":"Practice guidelines for the diagnosis and management of systolic heart failure in low- and middle-income countries.","volume":"8","author":"Baliga","year":"2013;","journal-title":"Glob Heart"},{"issue":"(11):","key":"key20260223050159_B37","doi-asserted-by":"crossref","first-page":"2185\u2013","DOI":"10.1002\/ejhf.2620","article-title":"Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease: from physician's prescriptions to patient's dispensations, medication adherence and persistence.","volume":"24","author":"Janse","year":"2022;","journal-title":"Eur J Heart Fail"},{"issue":"(10):","key":"key20260223050159_B38","doi-asserted-by":"crossref","first-page":"1173\u2013","DOI":"10.1093\/eurjhf\/hft134","article-title":"Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry.","volume":"15","author":"Maggioni","year":"2013;","journal-title":"Eur J Heart Fail"},{"issue":"(17):","key":"key20260223050159_B39","doi-asserted-by":"crossref","first-page":"1585\u2013","DOI":"10.1016\/j.jacc.2013.04.086","article-title":"Safety and efficacy of eplerenone in patients at high risk for hyperkalemia and\/or worsening renal function: analyses of the EMPHASIS-HF study subgroups (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure).","volume":"62","author":"Eschalier","year":"2013;","journal-title":"J Am Coll Cardiol"},{"issue":"(6):","key":"key20260223050159_B40","doi-asserted-by":"crossref","first-page":"1278\u2013","DOI":"10.1002\/ejhf.3295","article-title":"How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC.","volume":"26","author":"Savarese","year":"2024;","journal-title":"Eur J Heart Fail"},{"issue":"(6):","key":"key20260223050159_B41","doi-asserted-by":"crossref","first-page":"1374\u2013","DOI":"10.1177\/08971900241256725","article-title":"Optimizing finerenone in people with diabetes and chronic kidney disease: an opportunity for the pharmacist.","volume":"37","author":"Goldman","year":"2024;","journal-title":"J Pharm Pract"},{"issue":"(21):","key":"key20260223050159_B42","doi-asserted-by":"crossref","first-page":"6398.","DOI":"10.3390\/jcm13216398","article-title":"Finerenone: a third-generation MRA and its impact on cardiovascular health\u2014insights from randomized controlled trials.","volume":"13","author":"Sabina","year":"2024;","journal-title":"J Clin Med"},{"key":"key20260223050159_B43","doi-asserted-by":"crossref","first-page":"25\u2013","DOI":"10.1016\/j.ijcard.2015.05.127","article-title":"Safety profile of mineralocorticoid receptor antagonists: spironolactone and eplerenone.","volume":"200:","author":"Lainscak","year":"2015;","journal-title":"Int J Cardiol"},{"issue":"(4):","key":"key20260223050159_B44","doi-asserted-by":"crossref","first-page":"153\u2013","DOI":"10.1002\/clc.20324","article-title":"A comparison of the aldosterone-blocking agents eplerenone and spironolactone.","volume":"31","author":"Struthers","year":"2008;","journal-title":"Clin Cardiol"},{"key":"key20260223050159_B45","doi-asserted-by":"crossref","first-page":"53767\u2013","DOI":"10.12775\/QS.2024.17.53767","article-title":"Current state of knowledge about spironolactone-induded gynecomastia. Review 2024.","volume":"17:","author":"Iszczuk","year":"2024;","journal-title":"Qual Sport"},{"issue":"(2):","key":"key20260223050159_B46","doi-asserted-by":"crossref","first-page":"152\u2013","DOI":"10.1093\/eurheartj\/ehaa736","article-title":"Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine.","volume":"42","author":"Agarwal","year":"2021;","journal-title":"Eur Heart J"},{"issue":"(1):","key":"key20260223050159_B47","doi-asserted-by":"crossref","first-page":"489.","DOI":"10.1186\/s12872-024-04103-7","article-title":"Comparative effectiveness and safety of eplerenone and spironolactone in patients with heart failure: a systematic review and meta-analysis.","volume":"24","author":"Elshahat","year":"2024;","journal-title":"BMC Cardiovasc Disord"},{"issue":"(12):","key":"key20260223050159_B48","doi-asserted-by":"crossref","first-page":"3992.","DOI":"10.3390\/jcm12123992","article-title":"Finerenone: questions and answers\u2014the four fundamental arguments on the new-born promising non-steroidal mineralocorticoid receptor antagonist.","volume":"12","author":"Di Lullo","year":"2023;","journal-title":"J Clin Med"},{"issue":"(1):","key":"key20260223050159_B49","doi-asserted-by":"crossref","first-page":"105\u2013","DOI":"10.1016\/j.ihj.2017.11.015","article-title":"Management protocols for chronic heart failure in India.","volume":"70","author":"Mishra","year":"2018;","journal-title":"Indian Heart J"}],"container-title":["Journal of The Association of Physicians of India"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:02:12Z","timestamp":1771822932000},"score":1,"resource":{"primary":{"URL":"https:\/\/japi.org\/article\/japi-74-1-s1-32"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":49,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.59556\/japi.74.1298"],"URL":"https:\/\/doi.org\/10.59556\/japi.74.1298","relation":{},"ISSN":["0004-5772"],"issn-type":[{"value":"0004-5772","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}