Acute heart failure
MRA efficacy has also been investigated in patients with acute HF. The ATHENEA-HF trial (Efficacy and safety of spironolactone in acute HF) showed that the addition of high dose spironolactone to usual care for patients with acute HF did not change NT-proBNP levels and did not improve symptoms, congestion and clinical outcomes (Butler et al., 2017). Moreover, concentrations of spironolactone and its metabolites were measured in patients receiving high doses of spironolactone, showing that these concentrations were lower than anticipated (de Denus et al., 2020). Furthermore, the EARLIER trial (Efficacy and Safety of Early Initiation of Eplerenone Treatment in patients with acute HF) demonstrated that although the early initiation of eplerenone treatment in acute HF patients was safe, the incidence of CV death or re-hospitalization was not reduced (Asakura et al., 2020).