The HFpEF-ABA Score, Incident Heart Failure, and Finerenone in Chronic Kidney Disease with Type 2 Diabetes

Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) face high but modifiable risks of incident heart failure (HF). We aimed to ascertain whether the HFpEF-ABA score, a simple three-variable tool to facilitate timely diagnosis of HFpEF, is associated with adverse cardiovascular (CV) outcomes in patients with CKD and T2D but without HF.

In this participant-level pooled analysis of the FIDELITY program, including FIDELIO-DKD and FIGARO-DKD, HFpEF-ABA scores (based on age, body mass index, and atrial fibrillation status) were calculated at baseline. Clinical outcomes and treatment effects of finerenone versus placebo were evaluated according to continuous and categorical (low/intermediate, <75%; high, ≥75%) HFpEF-ABA scores among FIDELITY participants without HF.

Among 12,990 FIDELITY participants, 11,950 (mean age, 65±10 years; 30% female; median HFpEF-ABA score, 62%[47%,77%]) had a calculable HFpEF-ABA. Among FIDELITY patients without HF, those with a high (28%) vs. low/intermediate (72%) HFpEF-ABA score had a higher rate of CV death or incident HF hospitalization (HR, 2.18; 95% CI, 1.86‒2.55; P < .001), incident HF hospitalization (HR, 2.61; 95% CI, 2.13‒3.19; P < .001), and CV death (HR, 1.79; 95% CI, 1.41‒2.26; P < .001). Finerenone reduced CV death or incident HF hospitalization irrespective of baseline HFpEF-ABA score category (P_interaction = 0.68), with greater absolute benefits among those with a high (absolute rate reduction [ARR], 0.8 per 100 person-years) vs. low/intermediate (ARR, 0.2 per 100 person-years) HFpEF-ABA score. Serious adverse events were less common with finerenone vs. placebo in both HFpEF-ABA score categories.

Among persons with CKD and T2D, the HFpEF-ABA model identified increased risks of incident HF and CV death. Finerenone consistently reduced CV events across a broad HFpEF-ABA score spectrum.