Heart failure & cardiomyopathiesCohort study
Steroidal vs. non-steroidal mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction: a propensity-matched multi-network nationwide cohort study
- retrospective observational cohort study
- 1:1 propensity score matching (PSM)
- TriNetX research network
Authors' conclusion
In this large real-world HFpEF cohort, finerenone use was associated with lower risks of HF exacerbation and all-cause mortality compared with spironolactone. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.
Study context
- Population
- Patients with HF with preserved ejection fraction (HFpEF) initiated on finerenone vs. spironolactonepatients with HFpEF and MRA use, after PSM, each cohort contained 491 patients
- Participants
- 254,417 patients
- Exposure
- patients with HFpEF initiated on finerenone vs. spironolactone
- finerenonen = 491
- spironolactonen = 491reference
Main finding
HF exacerbation · 1-year
Hazard ratio
0.63
95% CI 0.54–0.74
P < 0.001
finerenone vs spironolactone
HR 0.63 (95% CI 0.54–0.74); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality · 1-year · lower risk with finerenone · after PSM | 0.38 (0.23–0.64) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Subgroup analysis by diabetes mellitus and chronic kidney disease
- Heart failure (HF) exacerbation, all-cause mortality, hypokalaemia and reduction in acute kidney injury (AKI) risk statistically significant after stratified subgroup analysis
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Hypokalaemia · 1-year · lower risk with finerenone · after PSM | 0.58 (0.40–0.85) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
Original publication
Steroidal vs. non-steroidal mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction: a propensity-matched multi-network nationwide cohort study. Eur Heart J Qual Care Clin Outcomes. Published 30 January 2026. doi:10.1093/ehjqcco/qcag014
Summarised from the published abstract; every number is checked against it