Medical training and mini-Delphi approach to implement heart failure treatment with mineralocorticoid receptor antagonists

Background. Mineralocorticoid receptor antagonists (MRAs) are a class of drugs still underused in heart failure with reduced ejection fraction. Hyperkalemia, worsening of renal function and gynecomastia are the main causes of the MRA missed prescription but also an inadequate knowledge of this class of drugs may represent a reason for their underuse. The aim of this project was to evaluate the possible usefulness of a unique and innovative web-based platform in order to identify the main issues related to the underuse of MRAs and to discuss shared strategies of interventions to overcome the obstacles to MRA prescription. Methods. The “HF Clinical Practice project” enrolled 55 hospital cardiologists. It was based on the development and production of the eCaseTrack platform which was capable of activating a content-sharing system between professionals and specialists, using a mixed-methods study consisting of a survey, shared clinical experiences, training and consensus mini-Delphi method. Results. The results of the survey showed that the respondents substantially agreed about the criteria for MRA prescription (NYHA class, left ventricular ejection fraction, glomerular filtration rate and serum potassium). This agreement was confirmed by mini-Delphi, by which the use of MRAs in patients with hypotension, hyperkalemia and gynecomastia emerged as the most controversial issue. Conclusions. A web-based system of sharing clinical experiences and discussing controversial issues, is useful to implement the introduction of a proven efficacious therapeutic strategy which is still underused in current clinical practice.