Finerenone reduced cardiovascular death and total heart failure events consistently across polypharmacy groups, including 31% with hyper-polypharmacy, with no increase in adverse events.
Does finerenone reduce cardiovascular death and total HF events in patients with HFmrEF/HFpEF regardless of baseline polypharmacy?
Finerenone safely reduces cardiovascular death and total heart failure events in patients with HFmrEF/HFpEF, with consistent benefits regardless of the patient's baseline medication burden.
Abstract Aims Patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) have a high comorbidity burden, which may necessitate numerous medications. Patients and clinicians may be hesitant about initiating another medication, especially among those already experiencing polypharmacy. This prespecified analysis sought to examine the efficacy and safety of adding finerenone based on the concomitant medication number. Methods and results: In the FINEARTS-HF trial, baseline medication use was collected in all 6,001 participants with HFmrEF/HFpEF. Clinical outcomes and treatment effects were assessed by the categories of total medication count (“non-polypharmacy”: ≤4 medications; “polypharmacy”: 5 to 9 medications; and “hyper-polypharmacy”: ≥10 medications) and as continuous variables. The primary outcome was a composite of cardiovascular death and total HF events. Overall (age: 72±10 years; 46% women), the total number of medications at baseline ranged from 0 to 29 (mean: 8.4±3.6), with 3,588 (60%) meeting polypharmacy and 1,878 (31%) meeting hyper-polypharmacy. Incidence rates for the primary outcome increased across medication categories: non-polypharmacy, 10.2; polypharmacy, 12.3; and hyper-polypharmacy, 26.1 per 100 person-years. The treatment benefits of finerenone in reducing the primary outcome were consistent across the spectrum of total medication count (Pinteraction=0.94). Any serious adverse events and study drug discontinuation were not more frequent with finerenone vs placebo, regardless of polypharmacy categories. Conclusions In FINEARTS-HF, 90% of patients with HFmrEF/HFpEF met the criteria for polypharmacy or hyper-polypharmacy, and these patients faced excess risks of cardiovascular events. Finerenone safely reduced cardiovascular death and total HF events across a broad range of baseline medication use.
Okada et al. (2026) studied this question. Finerenone reduced cardiovascular death and total heart failure events consistently across polypharmacy groups, including 31% with hyper-polypharmacy, with no increase in adverse events.
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