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Optimizing MRA Use in HF Management
A 55-year-old man with a history of heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction [LVEF] 55%) presents for evaluation. He endorses dyspnea on exertion, general fatigue, and labile weight. Recent right heart catheterization findings included right atrial pressure 11 mm Hg and pulmonary wedge pressure 15 mm Hg. His medical history includes coronary artery disease, three coronary artery bypass graft surgeries, hypertension, hyperlipidemia, obstructive sleep apnea, obesity, and a solitary kidney. His medications include aspirin 81 mg once daily, clopidogrel 75 mg once daily, bumetanide 2 mg once daily, dapagliflozin 10 mg once daily, losartan 50 mg once daily, metoprolol tartrate 25 mg twice daily, omeprazole 20 mg once daily, and rosuvastatin 40 mg once daily.
His blood pressure (BP) is 109/74 mm Hg, heart rate (HR) is 71 bpm, and weight in the clinic is 129.9 kg. Laboratory study results include potassium (K+) level 3.9 mEq/L and creatinine (Cr) level 1.2 mg/dL with estimated glomerular filtration rate (eGFR) >60 mL/min/m2.
During his initial clinic visit, the patient was started on finerenone 20 mg once daily.
The patient returns to the clinic approximately 4 weeks after finerenone initiation. He reports that his shortness of breath has improved and weight has been more stable at home. His medications include aspirin 81 mg once daily, clopidogrel 75 mg once daily, bumetanide 2 mg once daily, dapagliflozin 10 mg once daily, finerenone 20 mg once daily, losartan 50 mg once daily, metoprolol tartrate 25 mg twice daily, omeprazole 20 mg once daily, and rosuvastatin 40 mg once daily.
He has euvolemia on examination. His BP is 118/81 mm Hg, HR is 67 bpm, and weight in the clinic is 125.8 kg.
New laboratory study results include K+ level 4.1 mEq/L and Cr level 1.2 mg/dL with eGFR >60 mL/min/m2.
Which one of the following is the best next step?
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