Finerenone Shows Consistent Efficacy in Heart Failure Regardless of Atrial Fibrillation Status: Study

Key Findings

AF patients were at increased risk for HF events and cardiovascular mortality compared with no AF:

• Event rate per 100 person-years:

• Paroxysmal AF: 20.3 (95% CI, 17.9-23.1)

• Persistent or permanent AF: 19.8 (95% CI, 17.8-22.0)

• No AF: 11.9 (95% CI, 10.7-13.3)

Rate ratio (RR) for primary outcome:

• Paroxysmal AF vs. no AF: 1.62 (95% CI, 1.37-1.92)

• Persistent or permanent AF vs. no AF: 1.66 (95% CI, 1.43-1.93)

Finerenone had significant benefit on the primary outcome with an overall RR of 0.84 (95% CI, 0.74-0.95), which was consistent in all AF subgroups:

• No AF: RR 0.80 (95% CI, 0.65-0.98)

• Paroxysmal AF: RR 0.83 (95% CI, 0.65-1.06)

• Persistent or permanent AF: RR 0.85 (95% CI, 0.69-1.05)

• There was no considerable interaction between AF status and finerenone's impacts (p=0.94).

• AFL or new-onset AF was found in 6.5% of patients and represented a significantly higher risk for cardiovascular death and HF events (RR 3.65, 95% CI, 2.57-5.18; p<0.001).

• The rate of new-onset AF or AFL was lower in the finerenone group, with a subdistribution hazard ratio of 0.77 (95% CI, 0.57-1.04; P = .09), although this did not quite achieve significance.

The results of the FINEARTS-HF trial support finerenone as a beneficial treatment option for HF patients, both with and without AF. The findings emphasize the importance of early intervention in HF patients, especially in those at risk of developing AF.

Reference:

Matsumoto S, Henderson AD, Jhund PS, et al. Finerenone and Atrial Fibrillation in Heart Failure: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial. JAMA Cardiol. Published online March 29, 2025. doi:10.1001/jamacardio.2025.0848