The Role of MRAs in the Management of HF-Patient Management Factors and Subpopulations

Video Transcription

Video Summary

Emma Siegel, a pharmacist, discusses the management of mineralocorticoid receptor antagonists (MRAs) in heart failure patients, focusing on monitoring, side effects, and special populations. Key monitoring includes renal function (eGFR cutoffs: ≤30 for steroidal MRAs, ≤25 for finerenone) and potassium levels (avoid initiation if potassium ≥5). Hyperkalemia is dose-dependent and managed by dose adjustment, dietary counseling, and potassium binders. Finerenone shows a lower hyperkalemia risk than steroidal MRAs. Creatinine increases are usually transient and reversible. Steroidal MRAs, especially spironolactone, can cause hormonal side effects like gynecomastia, mitigated by switching to more selective MRAs. Finerenone benefits patients with type 2 diabetes and chronic kidney disease by reducing cardiovascular and renal outcomes and may lower atrial fibrillation risk. MRAs are contraindicated in pregnancy and require caution during lactation. Drug interactions, especially with CYP3A4 inhibitors, and cost considerations affect MRA selection. Overall, patient-specific factors guide MRA use to optimize heart failure care.

Keywords

mineralocorticoid receptor antagonists

heart failure management

hyperkalemia monitoring

finerenone benefits

MRAs side effects