EMPEROR-Preserved Score Predicts Outcomes and Identifies Greater Absolute Benefit with Finerenone
In the FINEARTS-HF Trial, the EMPEROR-Preserved Trial risk score showed broad applicability across outcomes. While baseline risk did not alter the relative treatment effect of Finerenone, higher-risk patients derived greater absolute benefit. Overall, the score is a useful tool for individualized risk stratification, estimating treatment benefit, and improving patient selection in future HFmrEF and HFpEF trials. The study was published in JAMA Cardiology by Misato C. and colleagues.
Consistent therapeutic effects of finerenone were observed across all risk level categories in patients with heart failure and mildly reduced ejection fraction, and biomarker-driven risk models were shown to predict prognosis effectively. Patients with heart failure and preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF) display significant variability in clinical outcomes, making risk stratification and therapeutic decision-making difficult. This secondary analysis of a pre-specified hypothesis explored prognostic risk models based on the EMPEROR-Preserved trial in the context of the FINEARTS-HF population.
This secondary analysis was carried out using data collected in the randomized clinical trial FINEARTS-HF, which included patients from 653 sites in 37 different countries. Patients aged 40 years and above with symptomatic heart failure and left ventricular ejection fraction (LVEF) ≥40% were included.
In this trial, there were 6,001 patients with a mean age of 72.0 (±9.6) years. Of these, 2,732 (45.5%) were women. Patients were randomized to receive either finerenone or placebo. Patients receiving finerenone totaled 3,003, while those receiving placebo totaled 2,998. The median time to event was 32 months (IQR 23–37).
Key findings:
A total of 6,001 patients were analyzed across 653 sites in 37 countries.
Patients in the highest risk quintile (Q5) had a hazard ratio of 10.49 (95% CI 8.14–13.52) for HF hospitalization or cardiovascular death compared with Q1.
For cardiovascular death alone, Q5 vs Q1 hazard ratio was 13.47 (95% CI 8.79–20.64).
Finerenone treatment effects across risk quintiles were:
Q1: HR 0.93 (95% CI 0.58–1.49)
Q2: HR 1.04 (95% CI 0.76–1.43)
Q3: HR 0.82 (95% CI 0.62–1.07)
Q4: HR 0.81 (95% CI 0.65–1.01)
Q5: HR 0.88 (95% CI 0.74–1.05)
No significant interaction across risk groups was observed (P = 0.68).
Risk models driven by biomarkers have been shown to accurately predict outcomes in patients with HFpEF and HFmrEF, and finerenone has shown consistent clinical benefit across all risk profiles.
Reference:
Chimura M, McDowell K, Jhund PS, et al. EMPEROR-Preserved Risk Model and Outcomes in the FINEARTS-HF Trial: A Prespecified Secondary Analysis of FINEARTS-HF. JAMA Cardiol. Published online March 28, 2026. doi:10.1001/jamacardio.2026.1049
