Finerenone may reduce worsening heart failure events by 18% in patients with mildly reduced or preserved ejection fraction compared with placebo, according to a recent trial.

In the recent international, double-blind, randomized trial (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure), published in The New England Journal of Medicine, researchers assessed the efficacy of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with heart failure and mildly reduced or preserved ejection fraction (left ventricular ejection fraction ≥ 40%). A total of 6,001 patients were randomly assigned to receive finerenone (up to 40 mg daily) or placebo, in addition to standard heart failure therapy.

Over a median follow-up of 32 months, finerenone significantly reduced the total worsening heart failure events, although the reduction in cardiovascular mortality was not statistically significant. Primary outcome events occurred in 624 of 3,003 patients in the finerenone group (1,083 events) compared with 719 of 2,998 patients in the placebo group (1,283 events) (rate ratio [RR] = 0.84, 95% confidence interval [CI] = 0.74–0.95, P = .007). Worsening heart failure events were also reduced in the finerenone group (842 vs 1,024 events, RR = 0.82, 95% CI = 0.71–0.94, P = .006).

However, there were no statistically significant differences in cardiovascular mortality between the two groups, with 8.1% of patients in the finerenone group and 8.7% of those in the placebo group experiencing cardiovascular death (hazard ratio = 0.93, 95% CI = 0.78–1.11). Although finerenone was associated with an increased risk of hyperkalemia (3.0% vs 1.4% in the placebo group), no deaths from hyperkalemia were reported. Hypokalemia occurred less frequently in the finerenone group.

The findings indicated that finerenone could be effective at reducing the risk of total worsening heart failure events in patients with mildly reduced or preserved ejection fraction. Nonetheless, the benefit in reducing cardiovascular mortality was not statistically significant. 

Full disclosures can be found in the published study.