Factors Associated With Mineralocorticoid Receptor Antagonist Initiation in Newly Diagnosed Heart Failure

Heart failure (HF) is increasingly recognized within the broader context of cardiovascular-kidney-metabolic (CKM) syndrome, characterized by the interrelationship of excess adiposity, metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease.1 The ability to initiate and maintain guideline-directed medical therapy (GDMT) may be particularly affected by the intersection of CKD and HF. Steroidal mineralocorticoid receptor antagonist (sMRA) remains among the least prescribed GDMT classes across the ejection fraction (EF) spectrum, possibly due to reported risks of worsening kidney function, hyperkalemia, and failure to demonstrate improvements in cardiovascular outcomes, especially among those with CKD.