Focus on finerenone: the FINEARTS-HF study

Mineralcorticoid receptor (MR) blockade is a mainstay of treatment for heart failure with reduced ejection fraction (HFrEF); however, the benefit is less well established in heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). The TOPCAT study failed to demonstrate a reduction in cardiovascular mortality and heart failure (HF) hospitalizations in this population but suggested potential benefits of mineralocorticoid receptor antagonists (MRAs) in specific patients subgroups. The FINEARTS-HF study, which evaluated the non-steroidal MRA finerenone in patients with HFmrEF or HFpEF, demonstrated a significant reduction in the primary composite endpoint of cardiovascular death and events related to worsening of heart failure (WHF), primarily driven by a decrease in total WHF events. Moreover, the FINEARTS-HF study demonstrated consistent efficacy across the entire left ventricular ejection fraction (LVEF) spectrum, regardless of sodium-glucose cotransporter 2 inhibitors use, sex, or age, with an early onset of benefit and a favourable safety and tolerability profile. Finerenone is currently indicated in class I in diabetic patients with chronic kidney disease to reduce the risk of HF; in light of the FINEARTS-HF results, it could become a new pillar of therapy for patients with HFpEF and HFmrEF.