Sleep Apnea Associated With Worsening HF Outcomes, With Sophia Schneider, MD, MS

Sleep apnea is associated with a higher risk of cardiovascular mortality and heart failure (HF) events, according to an 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 Sophia Schneider, MD, MS, an internal medicine resident at Brigham and Women’s Hospital.

“I think that the immediate impact is related to heightened recognition,” Schneider told HCPLive in an exclusive interview. “When we see patients with HFpEF and HFmrEF who have recurrent decompensations, difficult-to-control hypertension, or disproportionately high symptom burden, that should raise red flags for clinicians to be thinking about screening for sleep apnea to potentially get patients started on treatment.”

FINEARTS-HF was an international, double-blind trial enrolling patients with HF and a left ventricular ejection fraction (LVEF) ≥40%, who were assigned in a 1:1 ratio to either finerenone or placebo on top of standard therapy. Finerenone was administered at a maximum dose of either 20 or 40 mg once daily; placebo doses were matched. The primary outcome was a composite of total worsening HF events – defined as a first or recurrent unplanned hospitalization or urgent visit for HF – and cardiovascular death.2

A total of 6001 patients were included in the trial, with 3003 assigned to receive finerenone and 2998 assigned to placebo. Over the course of the 32-month program, investigators recorded 1083 primary-outcome events in 624 patients in the finerenone arm compared to 1283 events among 719 patients in the placebo group (rate ratio [RR], 0.84; 95% CI, 0.74-0.95; P = .007). The total number of worsening HF events was 842 in the finerenone arm and 1024 in the placebo arm (RR, 0.82; 95% CI, 0.71-0.94; P = .006). The percentage of cardiovascular mortalities was 8.1% and 8.7%, respectively (HR, 0.93; 95% CI, 0.78-1.11).2

In the present analysis, Schneider and colleagues created a primary composite endpoint of cardiovascular death and total HF events. Secondary outcomes included total HF events, cardiovascular death, KCCQ change, and all-cause mortality. Among the 6001 patients enrolled in the original trial, the presence or history of sleep apnea was investigator-reported.1

Of the original patients, 400 (6.7%) had sleep apnea. These patients were more often men (64% vs 54%), had a higher body mass index (BMI) (34 vs 29 kg/m2), and had a higher prevalence of diabetes (57% vs 40%). Over a follow-up period of 2.6 years, the team noted that sleep apnea was associated with a higher risk of the primary outcome (RR, 1.57; 95% CI, 1.38-1.79; P <.001). This correlation was consistent regardless of adjustment for age, sex, region, BMI, and diabetes history.1

Ultimately, the apparent solidity of these data belies the small proportion of patients in the study with confirmed sleep apnea. Schneider acknowledges this limitation, noting that sleep apnea was not confirmed with polysomnography, and details on the severity of the condition and its treatment status were not collected. This naturally limits the study’s broad applicability and, in Schneider’s opinion, calls for further research with a more structured definition of sleep apnea.

“I think that this overlap between these conditions suggests that there is a potential mechanism of intervention,” Schneider said. “Finerenone is likely one of these, especially given the outcomes that we saw in our study showing improved clinical outcomes in both patients with and without sleep apnea.”

Editors’ Note: Schneider reports no relevant disclosures.

References

1. Schneider S, Pabon M, Lu H, et al. Sleep Apnea in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: the FINEARTS-HF Trial. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.

2. 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