Does finerenone help patients with heart failure with mildly reduced ejection fraction?
Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) that has been studied in patients with heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40-49%). The FINEARTS-HF trial and a network meta-analysis provide evidence that finerenone can lower the risk of cardiovascular death and worsening heart failure events in this population. However, it may increase the risk of certain kidney outcomes, so your doctor will need to weigh the benefits and risks for you.
What the research says
A network meta-analysis of 27 randomized trials including over 65,000 patients found that finerenone, compared to placebo, reduced the risk of cardiovascular death by 11% (OR 0.89, 95% CI 0.82-0.95) and worsening heart failure events by 25% (OR 0.75, 95% CI 0.71-0.79) in patients with HFmrEF or HFpEF 3. However, finerenone was associated with a higher risk of composite renal outcomes (OR 1.42, 95% CI 1.10-1.84) 3.
The FINEARTS-HF trial, a large global randomized trial, specifically evaluated finerenone in patients with heart failure and LVEF ≥40% (including HFmrEF). The trial's design and rationale were published in 2024 9. Results showed that finerenone reduced the composite outcome of total worsening heart failure events and cardiovascular death 11. The benefit was consistent regardless of how recently a patient had a worsening heart failure event 11.
Regarding kidney outcomes, a prespecified analysis of FINEARTS-HF found that finerenone led to a numerically lower incidence of a sustained ≥50% decline in kidney function or kidney failure, but this was not statistically significant 10. Finerenone also reduced the urine albumin-to-creatinine ratio (UACR) compared to placebo 10. Your doctor will monitor your kidney function and potassium levels if you take finerenone.
It is important to note that the network meta-analysis also compared finerenone to SGLT2 inhibitors, another class of drugs used in heart failure. Finerenone was associated with a lower risk of worsening heart failure events compared to canagliflozin, but no significant differences were seen for other outcomes 3. The choice between these medications should be made with your doctor.
What to ask your doctor
- Given my ejection fraction and overall health, could finerenone be a good option for me?
- What are the potential benefits of finerenone for reducing my risk of heart failure hospitalization or death?
- What are the risks, especially regarding kidney function and potassium levels, and how will you monitor them?
- How does finerenone compare to other medications I am taking or could take, like SGLT2 inhibitors?
- Are there any specific symptoms or side effects I should watch for while taking finerenone?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.