Finerenone Reduces Worsening HF Events in Patients With Mildly Reduced or Preserved Ejection Fraction

Finerenone (KEREDIA) therapy may prevent worsening heart failure (HF) in outpatients with mildly reduced or preserved ejection fraction, according to the findings of a study reported in JAMA Cardiology.

In this secondary analysis of the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) study, researchers assessed 6,001 patients with HF and an ejection fraction of 40% or more. Patients from the population of interest were randomized 1:1 to treatment with finerenone or placebo. The primary end point events of interest were defined as cardiovascular (CV) death, hospitalization for HF, and outpatient urgent visit due to HF requiring IV diuretic therapy. Data analysis was conducted from September 1 to December 10, 2024.

The researchers recorded the following worsening HF events: 664 hospitalizations for HF, 87 urgent visits due to HF, and 1,250 oral diuretic intensifications. They noted that mortality rates were higher after worsening HF: 27.7% (95% CI, 24.3%-31.5%) per 100 patient-years after hospitalization for HF, 13.6% (95% CI, 8.8%-21.1%) per 100 patient-years after urgent visit due to HF, and 11.6% (95% CI, 10.2%-13.1%) per 100 patient-years after outpatient oral diuretic intensification compared with a rate of 4.5% (95% CI, 4.2%-4.9%) per 100 patient-years for patients without worsening HF.

Moreover, the results showed that addition of outpatient oral diuretic intensification to the primary outcome increased the number of patients experiencing events from 1,343 to 2,238. However, the use of finerenone therapy reduced outpatient oral diuretic intensification alone (hazard ratio [HR],  0.89; 95% CI, 0.80-0.98; P = .02) and as a composite outcome, which included CV death, hospitalization for HF, and urgent visit due to HF (HR,  0.85; 95% CI, 0.78-0.92; P < .001).

“These results support the use of outpatient oral diuretic intensification as a clinically relevant, early marker of worsening HF. Finerenone decreased the risk of oral diuretic intensification alone and as part of an extended composite outcome including CV death, HF hospitalizations, and urgent HF visits. Reductions in worsening HF events with finerenone in patients with HF with mildly reduced or preserved ejection fraction appear to extend to the outpatient setting,” the researchers concluded.

Source

Cunningham JW, Chatur S, Claggett BL, et al. Finerenone and outpatient worsening heart failure with mildly reduced or preserved ejection fraction: a secondary analysis of the FINEARTS-HF randomized clinical trial. JAMA Cardiol. Published online February 26, 2025. doi:10.1001/jamacardio.2025.0016