Although 27% of the patients with prevalent HFrEF had been prescribed a mineralocorticoid receptor antagonist in the 6 months prior to index, the use of medications taken later in the HF treatment pathway (sacubitril/valsartan, digoxin, ivabradine and hydralazine/nitrates) was low (0.3–15.3%). This evidence concerns the gene NR3C2 and hydrops fetalis.