Finerenone Efficacy in HF Unchanged by Ischemic Heart Disease, With Jawad Butt, MD, PhD

Patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), finerenone’s beneficial effects were consistent regardless of ischemic heart disease (IHD) status, according to a prespecified analysis of the FINEARTS-HF trial.1

These data were presented at the American College of Cardiology (ACC) Scientific Sessions 2026 in New Orleans, Louisiana, by Jawad Butt, MD, PhD, a research fellow in the department of cardiology at Copenhagen University Hospital and the University of Glasgow.1

“For clinicians, we know that the management of heart failure with a mildly reduced or preserved ejection fraction is complex,” Butt told HCPLive in an exclusive interview. “We know that ischemic heart disease is prevalent – we meet these patients in our everyday clinic. So the main take-home message for clinicians is that this treatment makes clinical decision-making so much easier, since we don’t have to differentiate between patients who do and do not have a history of IHD.”

FINEARTS-HF was a randomized, double-blind, placebo-controlled trial incorporating patients with symptomatic HF. Eligible patients were ≥40 years with New York Heart Association (NYHA) class II-IV HF, left ventricular ejection fraction (LVEF) ≥40%, or n-terminal prohormone B-type natriuretic peptide (NT-proBNP) ≥300 pg/mL in sinus rhythm, among other criteria. Patients were excluded if they exhibited an estimated glomerular filtration rate (eGFR) <25 mL/min/1.73m2 at screening or randomization, serum/plasma potassium >5 mmol/L at screening or randomization, or myocardial infarction, among other criteria.2

The study included a primary outcome of a composite of total worsening HF events, which were defined as first or recurrent unplanned hospitalization or urgent visit for HF and death from cardiovascular causes. The individual components were also assessed. The trial included a median follow-up period of 32 months.3

During the study, 3003 patients were randomized to receive finerenone, while 2998 were randomized to placebo. After the follow-up period, 1083 primary outcome events occurred in 624 patients in the treatment arm, and 1283 occurred among 719 patients in the placebo arm. The trial ultimately determined that finerenone reduced total worsening HF event rates and death from cardiovascular causes in these patients.3

The present secondary analysis included all 6001 patients, of whom 3236 had a history of IHD. After comparing these patients to those without IHD, Butt and colleagues noted a significantly higher risk of the primary outcome among those with IHD (risk ratio [RR], 1.54; 95% CI, 1.33-1.79), as well as each of the endpoint’s components (total HF events: RR, 1.54; 95% CI, 1.03-1.82; CV death: HR, 1.58; 95% CI, 1.29-1.94; all-cause death; HR, 1.34; 95% CI, 1.16-1.55), even after adjustment for known prognostic variables.1

However, the beneficial effect of finerenone on this primary outcome did not differ based on the presence of IHD (no IHD: RR, 0.81; 95% CI, 0.67-0.99; IHD: RR, 0.86; 95% CI, 0.73-1.01; P interaction = 0.68). Consistent effects were observed for all components of the primary outcome and all-cause death. Ultimately, Butt and colleagues determined that a history of IHD had no significant bearing on finerenone’s effects in HFmrEF/HFpEF.1

“Historically, we haven’t had many effective treatments in patients with HFmrEF/HFpEF, until SGLT2 inhibitors were approved some years ago,” Butt said. “Last year, the FDA approved finerenone for the treatment and management of these patients. Now that we have done several analyses, including looking at the efficacy and safety of finerenone on top of SGLT2 inhibitors, I definitely think this will get a place in international guidelines for the management of HFmrEF/HFpEF.”

Editors’ Note: Butt reports disclosures with AstraZeneca, Bayer, and Novartis.

References

1. Butt J, Jhund P, Henderson A, et al. Ischemic Heart Disease Does Not Modify the Beneficial Effects of Finerenone in HFmrEF/HFpEF: A Prespecified Analysis of the FINEARTS-HF Trial. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.

2. Bayer. Study to Evaluate the Efficacy (Effect on Disease) and Safety of Finerenone in Participants With Heart Failure and Left Ventricular Ejection Fraction (Proportion of Blood Expelled per Heart Stroke) Greater or Equal to 40% (FINEARTS-HF). ClinicalTrials.gov Identifier: NCT04435626. Updated August 26, 2025. Accessed April 7, 2026. https://clinicaltrials.gov/study/NCT04435626

3. Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. NEJM. 2024;391(16):1475-1485. doi:10.1056/nejmoa2407107