In patients with heart failure and sinus rhythm, higher baseline heart rate was associated with increased risk of cardiovascular death and heart failure events, but not in those with atrial fibrillati
Does finerenone improve clinical outcomes across the spectrum of baseline heart rates and rhythms in patients with HFmrEF/HFpEF?
Finerenone maintains consistent clinical efficacy in patients with HFmrEF/HFpEF regardless of baseline heart rate or the presence of atrial fibrillation.
Absolute Event Rate: 0% vs 0%
Abstract Aims The association between heart rate (HR) and clinical outcomes is well understood in patients with HFrEF, but less clear in those with HFmrEF/HFpEF, especially among individuals with AF. In a prespecified analysis of the FINEARTS-HF trial, we examined the association between baseline HR and clinical outcomes by heart rhythm and evaluated finerenone's effect across the spectrum of HR. Methods and results The primary outcome was a composite of cardiovascular death and total (first and recurrent) HF events. Heart rhythm (sinus rhythm or AF) was determined from the baseline ECG. Patients with pacemaker rhythm or missing HR/rhythm data were excluded. Among patients with sinus rhythm (SR n=3,497; 62%), higher baseline HR was associated with a higher incidence rate for the primary outcome. In patients with AF (n=2,190; 38%), no association between HR and outcomes was observed. The effect of finerenone on the primary outcome was consistent across the HR spectrum, regardless of rhythm (P for interaction=0.96 in SR; 0.49 in AF). In patients with SR, there was no significant HR change with finerenone versus placebo. In AF patients, finerenone led to a small but statistically significant HR reduction: a placebo-corrected decrease of 1.35 bpm (95% CI: 0.41 to 2.29) from baseline to 12 months. Conclusions Among patients with HFpEF/HFmrEF in FINEARTS-HF, higher baseline HR was associated with a higher risk of the primary outcome in patients with SR, but not in those with AF. Finerenone's effect on the primary outcome was consistent across the HR spectrum, irrespective of rhythm. Trial Registration ClinicalTrials.gov NCT04435626
Chimura et al. (Fri,) reported a other. In patients with heart failure and sinus rhythm, higher baseline heart rate was associated with increased risk of cardiovascular death and heart failure events, but not in those with atrial fibrillati.