MRAs may have lost their cornerstone position for heart failure treatment in the age of SGLT-2 inhibitors: A meta-analysis of randomized controlled trials

This study has already been registered with PROSPERO, CRD42022385023. Compared with SGLT-2 inhibitor monotherapy, combined treatment did not demonstrate more significant advantages in terms of heart failure or cardiovascular death (RR  = 1.00; 95% CI: 0.78–1.28), cardiovascular death (RR = 0.96; 95% CI: 0.61–1.52), heart failure hospitalization (RR = 0.92; 95% CI: 0.79–1.07), all-cause death (RR = 1.00; 95% CI: 0.63–1.59) and composite kidney endpoint (RR = 0.85; 95% CI: 0.49–1.46). Moreover, in comp arison to SGLT-2 inhibitors, combined therapy increased the risk of moderate-severe hyperkalemia (blood potassium >  6.0 mmol/l) (RR = 4.13; 95% CI: 2.23–7.65). In patients with HFrEF who have started MRAs treatment, the addition of an SGLT-2 inhibitor provides significant clinical benefit. However, the addition of MRAs to SGLT-2 inhibitors to treat heart failure is not essential.
Source: Heart Failure Reviews - Category: Cardiology Source Type: research