Clinical Report: Risk Model Stratifies Heart Failure Outcomes

Overview

A biomarker-driven risk model effectively stratified outcomes in heart failure patients with preserved or mildly reduced ejection fraction, enhancing treatment precision. The analysis of the FINEARTS-HF trial demonstrated that finerenone consistently reduced heart failure hospitalization or cardiovascular death across various risk quintiles, with biomarkers playing a crucial role.

Background

Heart failure remains a significant public health concern, particularly among patients with preserved ejection fraction. Accurate risk stratification is crucial for optimizing treatment strategies and improving patient outcomes. The integration of biomarkers into risk models may enhance the precision of outcome predictions in this patient population.

Data Highlights

Key Findings

• The EMPEROR-Preserved risk model demonstrated a 10-fold gradient in risk for heart failure hospitalization or cardiovascular death across quintiles, with statistical significance.
• Finerenone reduced the composite outcome of heart failure hospitalization or cardiovascular death consistently across all risk quintiles, with no significant interaction across the risk spectrum.
• Absolute risk reduction for the primary outcome varied significantly between the lowest-risk (3.7 events) and highest-risk (43.0 events) groups, indicating a need for tailored treatment approaches.
• Patients in higher-risk categories exhibited older age, lower ejection fraction, and higher prevalence of comorbidities, highlighting the need for comprehensive assessment.
• Incidences of hyperkalemia and elevated creatinine increased with higher risk, while hypokalemia was less common with finerenone, suggesting a favorable safety profile in certain populations.

Clinical Implications

The findings suggest that clinicians can utilize the EMPEROR-Preserved risk model to better stratify heart failure patients and tailor treatment with finerenone. Understanding the varying absolute benefits of finerenone based on baseline risk can inform shared decision-making and optimize patient management, ensuring that treatment aligns with individual patient risk profiles.

Conclusion

The study underscores the importance of biomarker-driven risk models in heart failure management and highlights the consistent efficacy of finerenone across different risk levels. Further research may enhance the applicability of these findings in clinical practice, particularly in diverse patient populations.

References

1. Chimura M, et al., JAMA Cardiology, 2024 -- Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF
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4. European Journal of Preventive Cardiology, 2025 -- Risk stratification for cardiovascular disease: a comparative analysis of cluster analysis and traditional prediction models
5. European Journal of Preventive Cardiology — Development of a Multimorbidity Risk Assessment Tool for Heart Failure Rehospitalization and Mortality: Incorporating Gut Microbiome Factors
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9. Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF | Trials | JAMA Cardiology | JAMA Network