The non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone reduces the rate of total worsening heart failure events and death from cardiovascular causes in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or with preserved ejection fraction (HFpEF) compared with placebo. These findings from the FINEARTS-HF trials were presented by Scott Solomon at the ESC Congress 2024.

The patients were randomly assigned to receive finerenone (maximum dose of 20 mg or 40 mg once daily; n = 3,003) or placebo (n = 2,998) in addition to usual therapy. After a median follow-up of 32 months, the rate of the composite primary outcome was lower in the finerenone group than in the placebo group (rate ratio 0.84, 95% CI 0.74–0.95, P = 0.007). The rate for each component of the primary outcome was also lower in the finerenone group than in the placebo group, with a total number of worsening heart failure events of 842 versus 1,024 (rate ratio 0.82, 95% CI 0.71–0.94, P = 0.006) and a percentage of deaths from cardiovascular causes of 8.1% versus 8.7% (HR 0.93, 95% CI 0.78–1.11). These results were consistent across all prespecified subgroups. Finerenone was associated with better patient-reported health status, as measured by the Kansas City Cardiomyopathy Questionnaire score, but did not improve the NYHA functional class or reduce the risk of the kidney composite outcome. With regard to safety end points, the incidence of serious adverse events was similar in the two groups, but patients receiving finerenone had a higher risk of hyperkalaemia and a decreased risk of hypokalaemia.