Real-world study of finerenone in patients with heart failure with preserved ejection fraction in Spain

To evaluate the effects of finerenone in patients with Heart failure with preserved ejection fraction (HFpEF), diabetes, chronic kidney disease, and albuminuria in Spain. This observational, retrospective multicenter study included adults with HFpEF, type 2 diabetes, chronic kidney disease, and albuminuria who started finerenone between June 1, 2024, and January 1, 2025. The patients were monitored over a six-month period. Hyperkalemia was defined as a serum potassium level > 5.5 mEq/L, and renal function deterioration as a > 25% decrease in baseline estimated glomerular filtration rate. The study included 96 participants with a median age [IQR] of 78.50 [74.00, 83.00] years; 64.4% were male. Hypertension was present in 88.5% of subjects, type 2 diabetes in 94.8%, and ischemic heart disease in 32.3%. Regarding treatments, 93.8% of patients were prescribed SGLT2 inhibitors, 59.4% renin-angiotensin system inhibitors, and 64.6% beta blockers. During follow-up, significant improvements in NYHA functional class and albuminuria were observed, together with a trend toward lower natriuretic peptide levels. There was no significant change in systolic blood pressure or glomerular filtration rate. At study end, 5.2% of patients died, 8.3% had a hospitalization related to HF, 13.5% discontinued finerenone, 5.2% experienced symptomatic hypotension, 10.4% developed hyperkalemia, and 16.7% showed a decline in renal function (>50%: 4.2%). In Spanish clinical practice, finerenone appears safe and is associated with improvements in functional class and albuminuria in patients with HFpEF, type 2 diabetes, CKD, and albuminuria.