Cardiometabolic & kidneySecondary analysis
Effects of Finerenone on Sudden Death Across the Cardio-Kidney-Metabolic Landscape
- Prespecified pooled participant-level analysis of 3 randomised trials (FINE-HEART)
- placebo-controlled
- centrally adjudicated by blinded committee
Authors' conclusion
The nonsteroidal mineralocorticoid receptor antagonist finerenone was associated with a lower risk of SD across the CKM spectrum.
Study context
- Population
- Patients with cardio-kidney-metabolic (CKM) syndrome: CKD with T2DM (FIDELIO-DKD, FIGARO-DKD) and HF with mildly reduced/preserved EF (FINEARTS-HF)
- Participants
- 18,991 patients · 3 RCTs
- Comparison
- Finerenone vs placebo
- Primary endpoint
- Sudden death
- Follow-up
- Median 2.9 years
Primary result
As reported in the abstract
Hazard ratio
0.81
95% CI 0.67–0.98
P = 0.034
Finerenone vs Placebo
HR 0.81 (95% CI 0.67–0.98); P = 0.034
Further findings
Sudden death incidence (pooled) · median follow-up 2.9 years
- Participants with SD
- 418 (2.2%)
- Rate
- 0.77 per 100 patient-years
- FINEARTS-HF vs CKD trials, per 100 patient-years
- 1.5 vs 0.5
Predictors of sudden death
- Higher risk with older age, history of HF, AF, prior MI, higher urine albumin-to-creatinine ratio, lower baseline SBP
Sudden death, by subgroup
- Relative risk reductions consistent across number of baseline CKM conditions
- P for interaction = 0.93
- Relative risk reductions consistent across trial
- P for interaction = 0.71
Original publication
Effects of Finerenone on Sudden Death Across the Cardio-Kidney-Metabolic Landscape. J Am Coll Cardiol. Published 3 June 2026. doi:10.1016/j.jacc.2026.04.045
Summarised from the published abstract; every number is checked against it