JAMA Cardiol

Finerenone delivers benefits in HFmrEF/HFpEF across all diuretic subgroups

August 21, 2025

Study details: This prespecified secondary analysis of the FINEARTS-HF randomized trial (NCT04435626) included 5,438 adults (mean age 72 years, 46% female) with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) across 653 sites in 37 countries. Patients were stratified by baseline diuretic regimen: nonloop diuretic, loop diuretic (≤40 mg or >40 mg furosemide equivalent), or both. Finerenone was titrated to 20 mg or 40 mg daily vs. placebo. Primary endpoint: composite of total heart failure events and cardiovascular death.

Results: Finerenone demonstrated consistent efficacy and safety across all diuretic subgroups. Compared with placebo, it reduced the risk of the composite endpoint and was associated with less need for loop diuretic dose escalation, along with a greater likelihood of dose reduction. The diuretic-sparing effect was most notable in patients receiving both loop and nonloop diuretics (rate ratio, 0.54; 95% confidence interval, 0.35–0.83). Finerenone also lowered the risk of hypokalemia but increased the incidence of hypotension and hyperkalemia, effects that were consistent across all diuretic groups. Importantly, its tolerability and safety profile remained stable regardless of whether loop diuretic doses were increased or decreased after randomization.

Clinical impact: Finerenone may offer a diuretic-sparing effect in HFmrEF/HFpEF, potentially reducing the need for higher loop diuretic doses and their associated risks. The findings support its use as an adjunct to standard therapy, with consistent safety across diuretic regimens.

Source:

Chimura M, et al. (2025, August 13). JAMA Cardiol. Efficacy and Tolerability of Finerenone According to the Use and Dosage of Diuretics: A Prespecified Analysis of the FINEARTS-HF Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40802267/