Finerenone reduced the composite primary endpoint of cardiovascular death and total worsening heart failure events by 16%.
This review synthesizes recent landmark trials that expand the therapeutic landscape for heart failure across all ejection fractions, highlighting new roles for SGLT2 inhibitors, non-steroidal MRAs, incretin therapies, and structural interventions.
Effect estimate: RR 0.84 (95% CI 0.74–0.95)
p-value: p=0.007
The interval since the 2021 European Society of Cardiology (ESC) Guidelines and 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) Guidelines publications has witnessed an unprecedented volume of evidence that substantially expands the therapeutic landscape across the entire ejection fraction (EF) spectrum. Major developments include the emergence of non-steroidal mineralocorticoid receptor antagonists and incretin-based therapies for heart failure (HF) with mildly reduced and preserved EF, the validation of rapid guideline-directed medical therapy optimization strategies in acute HF, and new evidence supporting digitalis glycosides in HF patients with reduced EF. Device-based care has evolved with transcatheter edge-to-edge repair for valvular heart disease. These data are likely to reshape contemporary clinical practice.
Liori et al. (2026) conducted a review in Heart Failure. Finerenone reduced the composite primary endpoint of cardiovascular death and total worsening heart failure events by 16%.
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