Heart failure & cardiomyopathies
Finerenone, eplerenone, and spironolactone in heart failure with preserved ejection fraction: a Bayesian network meta-analysis of efficacy and safety
Authors' conclusion
In HFpEF/HFmrEF, finerenone was the only MRA to significantly reduce hospitalization for HF, while no agent significantly reduced cardiovascular mortality and hyperkalaemia risk increased across therapies.
Study context
- Population
- Adults with heart failure with preserved ejection fraction (HFpEF) or HF with mildly reduced EF (LVEF ≥40%)
- Participants
- 10,644 adults · 8 RCTs
- Comparison
- Finerenone, eplerenone and spironolactone vs placebo
- Outcome
- Hospitalization for HF
Methodological detailsfixed-effects
- Fixed-effects
Pooled result
As reported in the abstract
Each group vs placeboRelative risk (95% CrI)
Finerenone
0.84(0.75–0.93)
Spironolactone
0.86(0.73–1.01)
Eplerenone
0.86(0.59–1.26)
Further pooled results
| Outcome | RR (95% CrI) | |
|---|---|---|
| CV mortalityFinerenone vs Placebo · CrI | 0.93 (0.78–1.10) | |
| CV mortalitySpironolactone vs Placebo · CrI | 0.93 (0.76–1.14) | |
| CV mortalityEplerenone vs Placebo · CrI | 1.10 (0.29–5.69) | |
| 0.20.5125Relative risk (log scale) |
- CV mortality: 95% CrI
CV mortality
- No MRA significantly reduced CV mortality vs placebo
Safety
| Outcome | RR (95% CrI) | |
|---|---|---|
| HyperkalaemiaFinerenone vs Placebo · CrI | 2.06 (1.77–2.41) | |
| HyperkalaemiaSpironolactone vs Placebo · CrI | 2.13 (1.81–2.53) | |
| HyperkalaemiaEplerenone vs Placebo · CrI | 2.17 (0.75–7.97) | |
| 0.10.31310Relative risk (log scale) |
- Hyperkalaemia: 95% CrI
Original publication
Finerenone, eplerenone, and spironolactone in heart failure with preserved ejection fraction: a Bayesian network meta-analysis of efficacy and safety. Eur J Heart Fail. Published 14 March 2026. doi:10.
Summarised from the published abstract; every number is checked against it