Heart failure & cardiomyopathiesCohort study
Finerenone versus spironolactone in heart failure with mildly reduced or preserved ejection fraction: a real-world study
- retrospective active-comparator, new-user cohort study
- propensity score matched 1:1
- TriNetX Network
Authors' conclusion
Finerenone initiation was associated with lower 12-month clinical event and hyperkalaemia risks than spironolactone initiation. These observational associations should be considered hypothesis-generating and require confirmation in randomised head-to-head trials.
Study context
- Population
- Adults of both sexes with HFmrEF/HFpEF initiating finerenone or spironolactone, 9 July 2021 to 31 March 2025patients in each group after matching
- Participants
- 1,417 adults
- Exposure
- finerenone versus spironolactone initiation
- Finerenonen = 1,417
- Spironolactonen = 1,417reference
- Outcome
- All-cause mortality or heart failure exacerbation
- Follow-up
- 12 months
Main finding
As reported in the abstract
Adjusted hazard ratio
0.72
95% CI 0.64–0.82
P < 0.001
By group
Finerenone vs Spironolactone
aHR 0.72 (95% CI 0.64–0.82); P < 0.001
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (95% CI) | |
|---|---|---|
| All-cause mortality | 0.67 (0.51–0.87) | |
| Heart failure exacerbation | 0.73 (0.64–0.83) | |
| All-cause hospitalisation | 0.83 (0.76–0.91) | |
| 0.512Adjusted hazard ratio (log scale) |
Acute myocardial infarction
- Lower risk not observed
Safety
| Outcome | Finerenone | Spironolactone | risk ratio (95% CI) | |
|---|---|---|---|---|
| Hyperkalaemia | 17.9% | 22.8% | 0.79 (0.68–0.91) | |
| 0.512Risk ratio (log scale) |
Acute kidney injury
- only a borderline difference
Original publication
Finerenone versus spironolactone in heart failure with mildly reduced or preserved ejection fraction: a real-world study. ESC Heart Fail. Published 30 September 2026. doi:10.1093/eschf/xvag246
Summarised from the published abstract; every number is checked against it