Finerenone Reduces Heart Failure Events Irrespective of Polypharmacy

Finerenone safely reduces cardiovascular death and total heart failure (HF) events among patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and polypharmacy, based on an analysis of the FINEARTS-HF trial.1

Presented at the 2025 Annual Heart Failure Society of America Scientific Meeting in Minneapolis, MN, on September 27, these data highlight the broad applicability of finerenone in treating both HFmrEF and HFpEF across a broad scope of patients with polypharmacy. The study aimed to ease hesitancy among both patients and clinicians about initiating other medications when faced with the high comorbidity burden of HF.1

Investigators analyzed patients who had enrolled in the FINEARTS-HF). For inclusion, patients had to exhibit an LVEF ≥40%, a NYHA class II-IV, elevated NTproBNP, LA enlargement or LVH, and recent diuretic use. Patients were excluded if they exhibited eGFR <25 ml/min/1.73m2, K >5.0 mmol/L, an alternative symptom cause, specific cardiomyopathy, or had used MRA within 30 days.2

The team divided polypharmacy into 3 core stages by baseline total medication. Non-polypharmacy included patients taking 0-4 medications, polypharmacy included those taking 5-9 medications, and hyper-polypharmacy covered patients taking ≥10 medications. The primary endpoint was cardiovascular death and total HF events, while secondary endpoints included all-cause death, non-cardiovascular death, and all-cause hospitalization.1

A total of 6001 patients were included in the FINEARTS-HF trial. Of these, 9% (n = 535) were in the non-polypharmacy group, 60% (n = 3588) were in the polypharmacy group, and 31% (1878) were in the hyper-polypharmacy group. Mean age was 72 +/- 10 years, and mean medication taken was 8.4 (standard deviation [SD] 3.6). Investigators then randomly assigned these patients in a 1:1 ratio to receive either finerenone 20mg, finerenone 40mg, or placebo.1,2

Ultimately, investigators found a hazard ratio for the composite outcome of cardiovascular death and total HF events of 1.07 in patients with polypharmacy (95% CI, 0.82-1.41; P <.001) and 1.54 in patients with hyper-polypharmacy (95% CI, 1.15-2.07; P <.001). Total HF events saw a hazard ratio of 1.10 in polypharmacy (95% CI, 0.79-1.53; P <.001) and 1.69 in hyper-polypharmacy (95% CI, 1.18-2.40; P <.001). All-cause hospitalization had a 1.22 hazard ratio in polypharmacy (95% CI, 1.04-1.43; P <.001) and 1.75 in hyper-polypharmacy (95% CI, 1.47-2.07; P <.001).1

Generally, patients with more medications were older and exhibited a greater burden of comorbidities. Incidence rates for cardiovascular death and HF events increased across medication categories, with non-polypharmacy averaging 10.2 events per 100ppy, polypharmacy averaging 12.3 per 100ppy, and hyper-polypharmacy at 26.1 per 100ppy. Treatment benefits of finerenone in reducing these outcomes were consistent across the medication use spectrum (P = .94). Adverse events leading to study drug discontinuation increased with the higher number of concomitant medications, but they were not more frequent with finerenone versus placebo.1

“Finerenone safely reduced cardiovascular death and total HF events across a broad range of baseline medication use, including among individuals with polypharmacy,” wrote Yasuhiro Hamatani, Kyoto Medical Center, and colleagues.1

References

1. Hamatani Y. Finerenone, Polypharmacy, and Clinical Outcomes in Heart Failure: Insights from the FINEARTS-HF Trial. Abstract presented at the 2025 Annual Heart Failure Society of America Scientific Meeting in Minneapolis, MN, September 27-29, 2025.

2. Mc Causland FR, Vaduganathan M, Claggett BL, et al. Finerenone and Kidney Outcomes in Patients With Heart Failure: The FINEARTS-HF Trial. J Am Coll Cardiol. 2025;85(2):159-168. doi:10.1016/j.jacc.2024.10.091