Current practice and perceptions on the use of mineralocorticoid receptor antagonists in the management of heart failure: A cross-sectional study among Indian physicians

Background: Mineralocorticoid receptor antagonists (MRAs) are a key component of guideline-directed therapy for heart failure (HF). Objective: This study explored the practices and perceptions of Indian physicians regarding MRA use in HF management. Methodology: A cross-sectional digital survey was conducted among Indian physicians from November 2022 to April 2023. Results: Of 528 responses, 75% of patients had HF with reduced ejection fraction (HFrEF), while 25% had HF with preserved EF (HFpEF). Hypertension was reported in 50% of HFrEF and 75% of HFpEF patients, with diabetes being a common comorbidity in 50% overall. MRAs were preferred by 88.6% of physicians, though only 37% considered them first-line therapy. Spironolactone was favored by 54.7%, while 45.3% chose eplerenone. Most of the physicians (92%) prescribed MRAs alongside loop diuretics. Initial spironolactone dosing was 25 mg in 77.8% of cases and 50 mg in 22% of cases. Reported benefits included improved New York Heart Association class (41.1%) and reduced hospitalizations (32.6%). Hyperkalemia incidence in patients on MRA was <25%, according to 80.9% of respondents. Despite recognized benefits, 84.5% felt MRAs were underdosed, and 83.4% believed that they were underutilized. Lack of awareness was cited by 43.8% as the primary reason for not using MRAs as a first-line therapy. Conclusion: Although MRAs are widely acknowledged as effective in HF treatment, underuse and suboptimal dosing remain challenges in India, largely due to limited awareness.