Heart failure & cardiomyopathies
Finerenone According to Frailty in Heart Failure: A Prespecified Analysis of the FINEARTS-HF Randomized Clinical Trial
Authors' conclusion
In FINEARTS-HF, finerenone reduced the risk of total worsening HF events and cardiovascular death, and it improved symptoms; these effects were not modified by frailty status.
Study context
- Population
- Patients with heart failure (HF), NYHA class II–IV, LVEF ≥40%, structural heart disease and elevated natriuretic peptides (HFmrEF or HF and preserved ejection fraction (HFpEF))Frailty index (FI) calculable
- Participants
- 5,952 patients
- Comparison
- Finerenone vs placebo, by frailty class
- Primary endpoint
- Composite of:
- CV death
- Total worsening HF events
Methodological detailsprespecified, phase 3, 653 sites in 37 countries, Randomised September 2020 to January 2023
- Prespecified
- Phase 3
- 653 sites in 37 countries
- Randomised September 2020 to January 2023
Primary result
As reported in the abstract
Primary outcome, finerenone vs placebo, by frailty class (Rockwood FI)
Finerenone vs PlaceboRelative risk (95% CI)
Class I frailty (FI ≤0.210), n = 1588
1.07(0.77–1.49)
Class II frailty (FI 0.211-0.310), n = 2141
0.66(0.52–0.83)
Class III frailty (FI ≥0.311), n = 2223
0.91(0.76–1.07)
Further findings
| Outcome | Unadjusted RR (95% CI) | |
|---|---|---|
| Primary outcome risk by frailty class (vs class I) — Class II frailty vs Class I frailty | 1.88 (1.54–2.28) | |
| Primary outcome risk by frailty class (vs class I) — Class III frailty vs Class I frailty | 3.86 (3.22–4.64) | |
| 0.20.5125Unadjusted relative risk (log scale) |
Components of primary outcome, all-cause death, KCCQ total symptom score improvement
- Frailty class did not modify the effects of finerenone
Safety
Hypotension, elevated creatinine, hyperkalemia, hypokalemia
- Effects of finerenone vs placebo did not differ by frailty class
Original publication
Finerenone According to Frailty in Heart Failure: A Prespecified Analysis of the FINEARTS-HF Randomized Clinical Trial. JAMA Cardiol. Published 1 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it