Finerenone May Help Prevent Worsening Heart Failure, suggests JAMA study

A recent secondary analysis of the FINEARTS-HF trial assessed the impact of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The trial assessed whether finerenone could decrease the necessity for outpatient oral diuretic escalation and its effect on clinical outcomes.

Patients with heart failure and an ejection fraction of 40% or more were enrolled in this worldwide, multicenter, double-blind randomized controlled trial. The trial compared finerenone versus a placebo effect on outpatient worsening HF events that necessitated the use of loop or thiazide diuretics. As worsening HF episodes, such as hospitalizations and urgent visits, are related to increased mortality risk, the recognition of effective treatment to control worsening HF episodes will be vital for enhancing patient outcomes.

The secondary analysis was based on the FINEARTS-HF trial data with 6,001 participants at a mean age of 72.0 years, 46% of whom were female (2,732 patients). The participants were allocated randomly to either finerenone or placebo in a 1:1 fashion.

Worsening HF events were defined as:

• HF hospitalizations (664 events)

• Urgent HF visits with intravenous diuretic treatment (87 events)

• Outpatient oral diuretic uptitration (1,250 events)

Primary outcome events, such as cardiovascular death, HF hospitalization, and urgent HF visits, were centrally adjudicated. Investigators measured the risk of mortality after each category of worsening HF event and assessed the effect of finerenone on outpatient intensification of oral diuretics alone and as included in an extended composite outcome of cardiovascular death, HF hospitalization, and urgent HF visits.

Key Findings

• HF hospitalization: 27.7 deaths per 100 patient-years (95% CI, 24.3-31.5)

• Urgent HF visits: 13.6 deaths per 100 patient-years (95% CI, 8.8-21.1)

• Outpatient oral diuretic intensification: 11.6 deaths per 100 patient-years (95% CI, 10.2-13.1)

• Patients without worsening HF: 4.5 deaths per 100 patient-years (95% CI, 4.2-4.9)

• Outpatient oral diuretic intensification considerably augmented the rate of patients having HF-related events from 1,343 to 2,238 cases.

• Finerenone lowered the hazard of outpatient oral diuretic intensification

• Hazard ratio (HR), 0.89 (95% CI, 0.80-0.98; p=0.02)

• Finerenone also decreased the risk in a longer composite outcome (CV death, HF hospitalization, urgent HF visit, and outpatient oral diuretic intensification); HR, 0.85 (95% CI, 0.78-0.92; p<0.001)

The research proved that finerenone minimized outpatient worsening HF events necessitating oral diuretic escalation in HFmrEF and HFpEF patients with increased risk of mortality. These findings highlight the importance of having finerenone as part of the treatment strategy for preserved ejection fraction heart failure patients, especially in minimizing outpatient worsening HF events.

Reference:

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