Finerenone Shows Consistent Efficacy in Heart Failure Regardless of Atrial Fibrillation Status: Study
Researchers have discovered in a study published in JAMA Cardiology that finerenone offers stable benefits in heart failure (HF) patients with mildly reduced or preserved ejection fraction, regardless of atrial fibrillation (AF) status. A new analysis of the FINEARTS-HF randomized clinical trial explored the effectiveness and safety of finerenone in these patients, focusing on outcomes in AF present and AF absent patients, including paroxysmal and persistent or permanent AF. The study was conducted by Shingo M. and colleagues.
There were 5984 patients with a mean age of 72.0 years (SD, 9.6) and a female percentage of 45.5%. Among the entire participants, 2714 (45.4%) were not having AF, 1384 (23.1%) were having paroxysmal AF, and 1886 (31.5%) were having persistent or permanent AF. Finerenone was given in titrated doses of 20 mg or 40 mg, and its effect was compared with that of a placebo. The main outcome assessed was a composite of total HF events and cardiovascular death, and new-onset AF or atrial flutter (AFL) was added as an exploratory endpoint.
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
