- Question
- Does finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduce heart failure events and cardiovascular death in patients with heart failure with mildly reduced or preserved ejection fraction?
- Design
- International, randomized 1:1, double-blind, placebo-controlled trial enrolling 6016 patients, with a median follow-up of 32 months; finerenone was added to usual therapy.
- Population
- Patients with symptomatic heart failure (NYHA class II-IV) and a left ventricular ejection fraction of 40% or greater.
- Intervention
- Finerenone once daily, at a maximum dose of 20 mg or 40 mg, on top of usual therapy.
- Control
- Matching placebo once daily, on top of usual therapy.
- Primary outcome
- Composite of total worsening heart failure events (first or recurrent unplanned hospitalization or urgent visit for heart failure) and death from cardiovascular causes.
- Results
- There were 1083 primary-outcome events in 624 of 3003 patients on finerenone and 1283 events in 719 of 2998 patients on placebo (rate ratio 0.84; 95% CI 0.74 to 0.95; P = 0.007). Total worsening heart failure events were 842 with finerenone and 1024 with placebo (rate ratio 0.82; 95% CI 0.71 to 0.94).
- Safety
- Finerenone was associated with a higher risk of hyperkalemia and a lower risk of hypokalemia.
- Conclusion
- In heart failure with mildly reduced or preserved ejection fraction, finerenone significantly lowered the composite of total worsening heart failure events and cardiovascular death compared with placebo.
- Why it matters
- It provided evidence of clinical benefit with a mineralocorticoid receptor antagonist in a patient group where this class had not clearly shown efficacy, broadening the therapeutic options.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026