Finerenone Reduces Heart Failure Events in Patients with Preserved or Mildly Reduced Ejection Fraction

Study at a glance:

• Journal: New England Journal of Medicine, 2024

• Population: 6001 patients with heart failure and left ventricular ejection fraction ≥40%

• Method: International, double-blind RCT comparing finerenone (20–40 mg daily) vs. placebo on top of usual therapy

• Key Finding: Finerenone reduced total worsening heart failure events and cardiovascular death compared to placebo

Summary:
This trial investigated the efficacy and safety of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with heart failure and mildly reduced or preserved ejection fraction. A total of 6001 patients were randomized to finerenone (n=3003) or placebo (n=2998) and followed for a median of 32 months. The composite primary outcome of total worsening heart failure events and cardiovascular death occurred in 1083 events in the finerenone group versus 1283 events in the placebo group (rate ratio 0.84; 95% CI, 0.74–0.95; P=0.007). Worsening heart failure events alone were also lower with finerenone (842 vs. 1024; rate ratio 0.82; 95% CI, 0.71–0.94; P=0.006). Cardiovascular death rates were similar (8.1% vs. 8.7%). Safety analysis showed increased hyperkalemia risk with finerenone but a lower risk of hypokalemia.

Takeaway:
Finerenone significantly reduces worsening heart failure events in patients with preserved or mildly reduced ejection fraction, offering a new therapeutic option while requiring monitoring for hyperkalemia.

Source:
Finerenone Heart Failure Trial Investigators. Finerenone in Heart Failure with Preserved or Mildly Reduced Ejection Fraction. N Engl J Med. 2024. doi:10.1056/NEJMoa2401123. Available at: https://www.nejm.org/doi/10.1056/NEJMoa2407107