Heart failure & cardiomyopathiesSecondary analysis
Interplay of Serum Potassium and Kidney Function with Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: Findings from FINEARTS-HF
- Secondary analysis of the FINEARTS-HF randomised trial
Authors' conclusion
No significant heterogeneity was found on the effect of finerenone to reduce primary outcome events.
Study context
- Population
- Patients with HFmrEF/HFpEF, by 4 categories of serum K+ (≤4.5 vs >4.5 mmol/L) and estimated glomerular filtration rate (eGFR) (≥60 vs <60 ml/min/1.73 m²)
- Participants
- 6,001 patients
- Comparison
- Finerenone vs placebo across serum K+/eGFR categories
- Primary endpoint
- Composite of:
- Total heart failure (HF) events
- CV death
- Follow-up
- Median 32 months
Primary result
As reported in the abstract
Total HF events and CV death, finerenone vs placebo, by K+/eGFR category (subgroup analysis)
- (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m²: RR
- 0.66 (0.52-0.85) (95% CI)
- (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m²: RR
- 0.92 (0.65-1.30) (95% CI)
- (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m²: RR
- 0.91 (0.74-1.13) (95% CI)
- (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m²: RR
- 0.92 (0.72-1.17) (95% CI)
- No significant interaction of finerenone (vs placebo) effect across K+/eGFR categories
- p for interaction = 0.20
Further findings
Prognosis by K+/eGFR category (across treatment groups)
- eGFR <60, irrespective of K+, vs K+ ≤4.5 and eGFR ≥60: 1.5- to 2-fold higher risk of primary outcome and fatal events
Safety
Adverse events and treatment discontinuation, by K+/eGFR category
- K+/eGFR categories did not significantly modify relative risk of adverse events with finerenone vs placebo
- P for interaction > 0.1 for all adverse events
- More frequent adverse events and treatment discontinuation with low eGFR and/or high K+
Original publication
Interplay of Serum Potassium and Kidney Function with Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: Findings from FINEARTS-HF. Eur J Heart Fail. Published 2 October 2025. doi:10.1002/ejhf.70052
Summarised from the published abstract; every number is checked against it