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Finerenone in Heart Failure With Improved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial
Maria A Pabon1, Orly Vardeny2, Muthiah Vaduganathan1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Cardiology
|May 21, 2025
Summary
Patients with improved heart failure ejection fraction (HFimpEF) still face high cardiovascular risks. Finerenone demonstrated consistent treatment benefits in HFimpEF patients, showing greater absolute risk reduction.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Patients with chronic heart failure (HF) and improved left ventricular ejection fraction (LVEF) to 40% or higher (HFimpEF) may still have residual cardiovascular risks.
- Understanding the clinical profiles and risks associated with HFimpEF is crucial for optimizing patient management.
Purpose of the Study:
- To assess the clinical characteristics, residual risks, and treatment response to finerenone in patients with HFimpEF.
- To evaluate the efficacy and safety of finerenone in a subgroup of patients with a history of LVEF < 40% within a larger HF trial.
Main Methods:
- A prespecified analysis of a randomized clinical trial involving 6001 patients with HF and LVEF ≥ 40% (including those with prior LVEF < 40%).
- Participants received finerenone (titrated to 20 mg or 40 mg) or placebo.
- The primary endpoint was a composite of cardiovascular death and worsening HF events.
Main Results:
- Patients with HFimpEF and a history of LVEF < 40% (n=273) experienced higher rates of the primary composite outcome compared to those with consistently LVEF ≥ 40% (21.4 vs 16.0 per 100 patient-years).
- After adjustment, this difference was not statistically significant (absolute RR, 1.13; 95% CI, 0.85-1.49).
- Finerenone's treatment effect was consistent between groups, with a greater absolute risk reduction observed in the HFimpEF subgroup (9.2 vs 2.5 per 100 patient-years). Safety profiles were similar, though hypotension was more frequent with finerenone in the HFimpEF group.
Conclusions:
- Patients with HFimpEF remain at high risk for cardiovascular events, necessitating continued management strategies.
- Finerenone provides consistent cardiovascular benefits in patients with HFimpEF, similar to the overall HF preserved ejection fraction population.
- The findings highlight the importance of ongoing risk assessment and treatment in HF patients despite improvements in LVEF.
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