Arrhythmias & electrophysiologySecondary analysis
Finerenone Reduces New-Onset Atrial Fibrillation Across the Spectrum of Cardio-Kidney-Metabolic Syndrome
- Prespecified pooled participant-level analysis of 3 randomised trials (FIDELIO-DKD, FIGARO-DKD, FINEARTS-HF)
- blinded adjudication
Authors' conclusion
The nonsteroidal MRA finerenone reduced the risk of new-onset AF/AFL across the CKM spectrum.
Study context
- Population
- Patients free of atrial fibrillation (AF)/atrial flutter (AFL) at enrollment with CKD and T2DM or heart failure (HF) with mildly reduced or preserved EF, across the cardio-kidney-metabolic (CKM) spectrum
- Participants
- 14,581 patients · 3 RCTs
- Comparison
- Finerenone vs placebo
- Primary endpoint
- New-onset AF/AFL
- Follow-up
- Median 2.9 years
Primary result
As reported in the abstract
median 2.9 years
Hazard ratio
0.83
95% CI 0.71–0.97
P = 0.019
Events by treatment group
Finerenone vs Placebo
HR 0.83 (95% CI 0.71–0.97); P = 0.019
Further findings
New-onset AF/AFL, by number of CKM conditions and by trial (subgroups)
- Risk reductions consistent irrespective of number of CKM conditions
- P for interaction = 0.87
- Risk reductions consistent by trial
- P for interaction = 0.57
New-onset AF/AFL, overall incidence
- Experienced new-onset AF/AFL
- 631 (4.3%)
Predictors of new-onset AF/AFL
- Older age, history of HF, higher BMI, geographic region, higher urine albumin-to-creatinine ratio
Outcomes after new-onset AF/AFL
- Significantly higher subsequent risk of CV death, HF hospitalization and adverse kidney outcomes
Original publication
Finerenone Reduces New-Onset Atrial Fibrillation Across the Spectrum of Cardio-Kidney-Metabolic Syndrome. J Am Coll Cardiol. Published 17 March 2025. doi:10.1016/j.jacc.2025.03.429
Summarised from the published abstract; every number is checked against it