Tackling Therapeutic Inertia on Mineralocorticoid Receptor Antagonist Adoption in Heart Failure.

Clinical inertia is a major cause of mineralocorticoid receptor antagonist (MRA) underuse and failure to intensify MRA dose in heart failure (HF). Hyperkalemia and worsening of renal function are the main causes of clinical inertia seen with MRA. However, evidence shows that the risk of hyperkalemia is not very high with MRA use, and patients often die due to MRA withdrawal rather than hyperkalemia itself. Hence, addressing this fear of hyperkalemia is important to improve MRA prescription and patient outcomes. Other androgenic side effects of MRAs should also be managed for better adoption of this guideline-directed medical therapy in HF.