Heart failure & cardiomyopathiesCohort study
Optimizing Mineralocorticoid Receptor Antagonist Therapy in Heart Failure Through Integrated Care Strategies
- prospective, observational study
- propensity-matched
- matched win-ratio
Authors' conclusion
A multidisciplinary approach combining dietary counseling, remote monitoring, and potassium binders was associated with improved optimization of MRA therapy in HFrEF patients at risk of hyperkalemia. This model may offer potential clinical benefit and underscores the value of team-based care in HF management.
Study context
- Population
- Patients with HFrEF at risk of hyperkalemiaafter 1:1 propensity matching, 82 pairs · exposure 51 · Medly 134
- Participants
- 185 patients
- Exposure
- Structured mineralocorticoid receptor antagonist (MRA) titration vs propensity-matched cohort followed on Medly
- exposuren = 51
- Medlyn = 134reference
Main finding
As reported in the abstract
Baseline potassium · baseline
P < 0.001
Observational data: associations, not effects.
Further findings
Use of potassium binders · higher in exposure group
P < 0.001
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| MRA optimization rates · higher with exposure | 4.67 (1.93–11.27) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
| Outcome | win ratio (95% CI) | P value | |
|---|---|---|---|
| Composite win ratio (death, HF hospitalization, LVEF improvement, hyperkalemic events) · favored the exposure group · matched win-ratio | 2.5 (1.3–6.35) | P = 0.005 | |
| 0.10.31310Win ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| HF hospitalizations · fewer with exposure | P = 0.014 |
- MRA optimization rates: after 1:1 propensity matching (82 pairs)
- Heart failure (HF) hospitalizations: after 1:1 propensity matching (82 pairs)
Original publication
Optimizing Mineralocorticoid Receptor Antagonist Therapy in Heart Failure Through Integrated Care Strategies. JACC Adv. doi:10.1016/j.jacadv.2026.102845
Summarised from the published abstract; every number is checked against it