The authors concluded that 2 distinctly different populations were enrolled in the 2 regions. The authors acknowledged that the overall neutral finding of TOPCAT would generally be considered the most reliable result of the trial, and that their post-hoc analysis should not be considered definitive. However, they concluded that the findings from the post-hoc analysis may be informative to those currently faced with clinical decisions for patients with heart failure with preserved ejection fraction with anticipated risk profiles similar to those enrolled in the Americas . The committee discussed the findings of the post-hoc analysis and agreed that, while interesting, it was not sufficient to support any recommendation to use MRAs in this population. Post-hoc subgroup analyses, while useful in hypothesis generation, are generally at high risk of bias and should always be interpreted with great caution. The previous guideline for chronic heart failure (CG108) included 8 studies which are referenced in the clinical review. These studies have all been excluded within this review as they no longer meet the review protocol. The committee discussed the current protocol for this review question and agreed that the previously included studies, which had a population of people with heart failure post myocardial infarction, were not appropriate for consideration within the review as these people represented a Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Research recommendation No recommendation significantly different population. In addition to this the committee agreed that the minimum duration of follow-up for included studies should be 6 months to ensure an accurate clinical effect can be established. In addition to this the committee agreed that cross-over studies should be excluded to ensure that potential carryover effects are not confounding the outcome. 