Comparative Study on the Mode of Action of Vicadrostat and Spironolactone on Protein Profiles and Renal Hemodynamic Effects (COMPARE-VS)

Inclusion Criteria: 1. Provided written and dated informed consent for participation prior to trial admission, 2. Age ≥18 years, female or male 3. Patients with * Heart failure\*1 (any LVEF) and eGFR\*2 between 25-90 mL/min/1.73m2 OR * Established cardiovascular disease\*3 and eGFR between 25-60 mL/min/1.73m2 OR * Established cardiovascular disease and type 2 diabetes and eGFR between 25-90 mL/min/1.73m2 4. Serum potassium ≤ 5.0 mmol 5. Currently treated or eligible for treatment with Empagliflozin\*4 6. Not using a MRA or AS inhibitor in the last 6 months prior to enrollment 7. On stable doses of other guideline directed medical therapies for ≥ 4 weeks prior to enroll-ment 8. Outpatient. * 1 HF is defined as the definition used in the most recent ESC guidelines for HF. * 2 eGFR as assessed by the 2009 CKD-EPI without the race coefficient * 3 Cardiovascular disease is defined as a history of a myocardial infarction, coronary bypass surgery, PCI, or proven coronary artery disease (e.g. by coronary angiography, CT-scan, etc.) * 4 If switching from another SGLT2i to Empagliflozin subjects can be enrolled directly. If the subject is not yet on SGLT2i and starts Empagliflozin enrollment can start 4 weeks later see criteria 8. Exclusion Criteria: 1. Inability to understand and sign informed consent 2. Absolute contra-indication for aldosterone antagonist 3. Absolute contra-indication for a SGLT2-inhibitor 4. Heart failure hospitalization, acute coronary syndrome, cardiac surgery, stroke or transient is-chemic attack in the 90 days prior to enrollment 5. Women who are pregnant, breastfeeding or may be considering pregnancy during the study duration.