Finerenone, a non-steroidal mineralocorticoid receptor antagonist, demonstrates cardiorenal benefits and reduces the risk of worsening heart failure events and cardiovascular death in HFmrEF/HFpEF.
Does finerenone improve clinical outcomes in patients with heart failure, particularly those with mildly reduced or preserved ejection fraction?
This review synthesizes evolving evidence that finerenone provides significant cardiorenal benefits and represents a new therapeutic option for managing heart failure, particularly HFmrEF and HFpEF.
Heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) represents approximately half of all HF cases, yet therapeutic options are limited. Mineralocorticoid receptor (MR) overactivation by aldosterone has long been recognized as a key driver of vascular inflammation, cardiac fibrosis, and cardiac hypertrophy, pathophysiological processes integral to the development and progression of HFmrEF/HFpEF. The non-steroidal MRA finerenone has been developed with a distinct pharmacological profile: potent and selective MR blockade with a reduced risk of off-target hormone-related side effects. Large, multicenter randomized placebo-controlled trials in chronic kidney disease and type 2 diabetes patients (FIDELIO-DKD, FIGARO-DKD) first highlighted finerenone's cardiorenal benefits, including a reduction in death from cardiovascular causes and hospitalization for HF. More recently, the FINEARTS-HF trial extended this evidence to patients with HFmrEF/HFpEF, demonstrating a significant reduction in the risk of worsening HF events and death from cardiovascular causes. Ongoing studies, such as REDEFINE-HF, CONFIRMATION-HF, and FINALITY-HF, will examine the potential role of finerenone in HF across a broad spectrum of ejection fractions and different clinical settings. This review synthesizes the evolving evidence supporting the role of finerenone as a new option in the management of HF.
Ismahel et al. (2025) conducted a review in Heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Finerenone was evaluated. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, demonstrates cardiorenal benefits and reduces the risk of worsening heart failure events and cardiovascular death in HFmrEF/HFpEF.