The New England Journal of MedicineFinerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

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The FINEARTS-HF trial evaluated finerenone’s efficacy in patients with heart failure and mildly reduced or preserved ejection fraction. This international, double-blind study showed significant reductions in heart failure events and cardiovascular death compared to placebo, while maintaining consistent benefits across subgroups, including patients on SGLT2 inhibitors.

Study Design:

• Population: 6,001 patients aged ≥40 years with symptomatic heart failure, LVEF ≥40%, structural heart disease, and elevated natriuretic peptides
• Intervention: Finerenone (20mg or 40mg daily) vs. placebo
• Duration: Median follow-up of 32 months
• Primary Outcome: Composite of total worsening heart failure events and cardiovascular death
• Baseline Characteristics: Mean LVEF 53±8%, 69.1% NYHA class II, 84.9% on beta-blockers, 13.6% on SGLT2 inhibitors

Key Findings:

• Primary Outcome Results: 1,083 events in finerenone group (n=624) vs. 1,283 events in placebo group (n=719); rate ratio 0.84 (95% CI, 0.74-0.95; P=0.007)
• Heart Failure Events: 842 events with finerenone vs. 1,024 with placebo (rate ratio 0.82; 95% CI, 0.71-0.94; P=0.006)
• Quality of Life: KCCQ symptom score improved by 8.0±0.3 points with finerenone vs. 6.4±0.3 points with placebo
• Safety: Hyperkalemia occurred in 3.0% of finerenone patients vs. 1.4% placebo; led to hospitalization in 0.5% vs. 0.2%
• Consistent Benefits: Results were similar across subgroups, including patients on SGLT2 inhibitors

HCN Medical Memo
Finerenone presents a viable treatment option for heart failure patients with preserved ejection fraction, with benefits extending beyond current standard therapy. Regular potassium monitoring is essential, but hyperkalemia rarely led to serious complications in the study population.

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