Finerenone and Outpatient Worsening Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial

Cunningham, JW; Chatur, S; Claggett, BL; Vaduganathan, M; Desai, AS; Jhund, PS; Llamas Esperón, G; Lam, CSP; Sato, N; Senni, M; Shah, S; Voors, A; Zannad, F; Pitt, B; Zieroth, S; Brinker, M; Rohwedder, K; Kim, SY; Lay-Flurrie, J; Viswanathan, P; McMurray, JJV; Solomon, SD

doi:10.1001/jamacardio.2025.0016

Heart failure & cardiomyopathies

Finerenone and Outpatient Worsening Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial

JAMA CardiolPublished 26 Feb 2025Secondary analysis of the FINEARTS-HF randomised trial

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Authors' conclusion

Outpatient worsening HF events requiring oral diuretic intensification were common, associated with poor prognosis, and reduced by finerenone in patients with HF with mildly reduced or preserved ejection fraction.

Study context

Population: Patients with heart failure (HF) and EF of 40% or greater (mildly reduced or preserved EF)
Participants: 6,001 patients

Comparison: Finerenone vs placebo
Primary endpoint: Outpatient oral diuretic intensification (initiation of loop or thiazide diuretic or increase in loop diuretic dosage), alone or in an extended composite with CV death, HF hospitalization and urgent HF visit

Methodological detailsprespecified, multicentre, global

Prespecified
Multicentre
Global

Primary result

As reported in the abstract

Finerenone vs PlaceboHazard ratio (95% CI)P value

Outpatient oral diuretic intensification alone

0.89(0.80–0.98)

P = 0.02

Extended composite (oral diuretic intensification, CV death, HF hospitalization, urgent HF visit)

0.85(0.78–0.92)

P < 0.001

Further findings

All-cause death rate after first worsening HF event, by type

Per 100 patient-years

After HF hospitalization (n = 664): 27.7 (95% CI, 24.3-31.5)
After urgent HF visit (n = 87): 13.6 (95% CI, 8.8-21.1)
After outpatient oral diuretic intensification (n = 1250): 11.6 (95% CI, 10.2-13.1)
Without worsening HF: 4.5 (95% CI, 4.2-4.9)

Patients with events when oral diuretic intensification added to primary outcome

Primary outcome → extended composite: 1343 to 2238

Original publication

Finerenone and Outpatient Worsening Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial. JAMA Cardiol. Published 26 February 2025. doi:10.1001/jamacardio.2025.0016

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