Heart failure & cardiomyopathiesMeta-analysis
Safety and efficacy of early initiation of mineralocorticoid receptor antagonist after an acute decompensated heart failure event or acute myocardial infarction with cardiac dysfunction: a meta-analysis of randomized clinical trials
- meta-analysis of randomized controlled trials
- pre-specified subgroup analysis by clinical setting (acute ischaemic vs non-ischaemic heart failure (HF))
Authors' conclusion
Early MRA initiation was associated with improved prognosis when compared with usual care, though accompanied by an increased risk of hyperkalaemia, warranting close follow-up after initiation.
Study context
- Population
- Patients with heart failure within a few weeks after a decompensation event or acute myocardial infarction with cardiac dysfunction
- Participants
- 9,770 Six randomized controlled trials (RCTs)
- Comparison
- Early MRA initiation vs usual care
Pooled result
All-cause death
Relative risk
0.87
95% CI 0.79–0.95
Early MRA vs usual care
RR 0.87 (95% CI 0.79–0.95)
As reported in the abstract
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Worsening HF | 0.81 (0.72–0.91) | |
| 0.512Relative risk (log scale) |
Hospital length
- No effect on hospital length
Efficacy by clinical setting (subgroup)
- Benefits consistent in acute ischaemic vs non-ischaemic HF
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Hypokalaemia | 0.39 (0.26–0.58) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Safety and efficacy of early initiation of mineralocorticoid receptor antagonist after an acute decompensated heart failure event or acute myocardial infarction with cardiac dysfunction: a meta-analysis of randomized clinical trials. ESC Heart Fail. Published 19 February 2026. doi:10.1093/eschf/xvag018
Summarised from the published abstract; every number is checked against it