This month’s Heart Failure Beat episode featured a debate between Stormi Gale, PharmD, BCCP, FHFSA and Robert L Page II, PharmD, MSPH, FHFSA on the role of mineralocorticoid receptor antagonists (MRAs) in HFpEF and HFmrEF.
Dr. Page made the case for finerenone as a potential “new pillar” in HFpEF, highlighting its unique pharmacology and cardiorenal distribution. He emphasized its “pleiotropic effects” and strong randomized trial data, particularly in patients with concomitant CKD. However, he acknowledged that cost-effectiveness remains a key question.
Dr. Gale countered with a pragmatic stance: “What I love even more than talking about mechanisms is evidence-based medicine.” She argued that without head-to-head trials, it’s difficult to justify a significantly higher price when spironolactone remains affordable and accessible.
The debate also explored phenotyping challenges in HFpEF. Dr. Gale noted that earlier trials may have unknowingly included patients with amyloidosis, emphasizing that “phenotyping is really important” as our understanding evolves.
Finally, the panel discussed emerging data suggesting that combining SGLT2 inhibitors with MRAs may attenuate hyperkalemia risk - a promising strategy that could expand safe GDMT optimization.
As the field awaits updated guidelines and further cost-effectiveness analyses, one message was clear: patient selection, access, and thoughtful application of evidence remain central to advancing care in HFpEF and HFmrEF.
🎧 Listen now to this episode.
Disclaimer:
The opinions and perspectives expressed in this episode are those of the individual guests and hosts and do not necessarily reflect the official views of the Heart Failure Society of America (HFSA). This discussion is intended for educational purposes only and does not constitute medical advice or an endorsement of any specific pharmaceutical product or therapy. HFSA does not endorse one medication over another. Patients should consult their healthcare professionals for individualized evaluation and treatment decisions.