Key result
Finerenone cuts total HF events and CV death ~15% across all HFpEF-ABA categories.
Why the study?
The study aimed to evaluate the HFpEF-ABA score in patients with confirmed HF in the FINEARTS-HF trial, its prognostic implications, and the effect of finerenone according to the score.
Does finerenone reduce total HF events and cardiovascular death across different HFpEF-ABA score categories in patients with HFmrEF/HFpEF?
RCT (n=5,988)
Double-blind
1:1
Yes
Does finerenone reduce total HF events and cardiovascular death across different HFpEF-ABA score categories in patients with HFmrEF/HFpEF?
The therapeutic effect of finerenone in patients with HFmrEF/HFpEF is consistent across the spectrum of HFpEF-ABA scores, despite one-third of patients having a low probability score.
HFpEF-ABA score stratifies prognosis in confirmed HF; leaves open its role for finerenone selection or enrichment.
BACKGROUND: The HFpEF-ABA score is a simple diagnostic tool developed to estimate the probability of heart failure with preserved ejection fraction (HFpEF) using age, body mass index, and history of atrial fibrillation. OBJECTIVES: This study aims to evaluate the HFpEF-ABA score in patients with confirmed heart failure (HF) in the FINEARTS-HF trial, its prognostic implications, and the effect of finerenone treatment according to the HFpEF-ABA score. METHODS: FINEARTS-HF was a randomized, placebo-controlled trial enrolling patients with HF with a left ventricular ejection fraction ≥40%. HFpEF-ABA scores (as a probability between 0% and 100%) were calculated at baseline and categorized as <75%, 75%-90%, or >90%. The association between HFpEF-ABA score and clinical outcomes was examined as well as the effect of finerenone across the range of HFpEF-ABA scores. RESULTS: Among 5,988 patients with available HFpEF-ABA scores, 1,940 (32.4%) had a score <75% (low probability), 1,241 (20.7%) had a score 75%-90% (intermediate probability), and 2,807 (46.9%) had a score >90% (high probability). Rates of HF outcomes were higher in patients with higher HFpEF-ABA scores. Examination of HFpEF-ABA score as a continuous variable showed a strikingly nonlinear association with outcomes; the rate of events was similar up to a score of ∼75%, above which there was a steep increase in the event rate. Finerenone reduced events consistently across HFpEF-ABA scores. CONCLUSIONS: Despite a proven diagnosis of HF with mildly reduced ejection fraction/HFpEF, one-third of participants in FINEARTS-HF had an HFpEF-ABA score <75%, yet the therapeutic effect of finerenone was consistent across the range of HFpEF-ABA scores included. Higher HFpEF-ABA scores were associated with a greater risk of HF events. (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure [FINEARTS-HF]; NCT04435626).
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Ono et al. (2026) conducted an RCT in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (HFmrEF/HFpEF) (n=5,988). Finerenone vs. Placebo was evaluated on Composite of total (first and recurrent) HF events (HF hospitalization or urgent HF visit) and cardiovascular death (results shown for the >90% HFpEF-ABA score subgroup) (RR 0.85, 95% CI 0.72-1.01, p=0.67 for interaction). Finerenone consistently reduced the composite of total heart failure events and cardiovascular death across all baseline HFpEF-ABA score categories, with a rate ratio of 0.85 in patients with a score >90%.
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