Are mineralocorticoid receptor antagonists (MRAs) ready for prime time in HFpEF and HFmrEF?

In this special debate-format episode of the Heart Failure Beat, two leading heart failure pharmacists, Stormi Gale, PharmD, BCCP, FHFSA and Robert L Page II, PharmD, MSPH, FHFSA, go head-to-head on steroidal vs non-steroidal MRAs.

From RALES and TOPCAT to FINEARTS-HF, they unpack the evidence, guideline implications, cost-effectiveness, CKM considerations, and real-world barriers to access. Is finerenone the “new pillar” in HFpEF? Or does spironolactone remain the practical, evidence-based choice? The conversation also explores phenotyping challenges in HF trials and whether combining SGLT2 inhibitors with MRAs can attenuate hyperkalemia risk.

If you care about precision medicine, cardiorenal overlap, or optimizing GDMT in complex patients, this debate is for you.

Heart failure care is entering a new era - one defined not by singular devices, but by integrated systems of technology working together. In this episode, Laura Peters, DNP, joins The Heart Failure Beat to discuss a new joint HFSA + AAHFN scientific statement on integrated health technologies. From wearables and implantable devices to telehealth and AI, the conversation explores how systems-based approaches, patient engagement, and multidisciplinary teams can improve outcomes while reducing burden on clinicians.

For decades, sodium restriction has been treated as a cornerstone of heart failure self-care—despite limited trial-quality evidence. In this episode of Heart Failure Beat, Dr. Tariq Ahmad (Yale School of Medicine; Associate Editor, JACC: Heart Failure) joins hosts Michael Beasley, MD, and Priya Umapathi, MD, to unpack what we actually know about sodium targets in hospitalized and outpatient heart failure. They discuss why inpatient studies have been inconsistent, why a VA-commissioned review concluded sodium restriction for admitted HF patients is not supported, and how focusing on “dietary indiscretion” can distract from evidence-based priorities like GDMT. Dr. Ahmad also previews the pragmatic, EHR-embedded SOAR-AHF trial designed to compare regular vs low-sodium hospital diets and measure outcomes like length of stay and readmissions.