Key result
High HFpEF-ABA score linked to ~118% higher major event risk, while finerenone reduces events across scores.
Why the study?
Patients with CKD and T2D face high risks of incident HF, but whether the 3-variable HFpEF-ABA score is associated with adverse CV outcomes in patients without HF was unknown.
Does finerenone reduce CV death or incident HF hospitalization compared to placebo in patients with CKD and T2D without HF, and does the HFpEF-ABA score modify this effect?
Cohort (n=11,950)
Does finerenone reduce CV death or incident HF hospitalization compared to placebo in patients with CKD and T2D without HF, and does the HFpEF-ABA score modify this effect?
The HFpEF-ABA score identifies patients with CKD and T2D at high risk for incident HF, and finerenone consistently reduces CV events across all score categories with greater absolute benefit in high-risk patients.
HFpEF-ABA score may stratify CV risk in CKD/T2D without HF; hypothesis-generating and requires prospective validation before clinical adoption.
Background Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) face high but modifiable risks of incident heart failure (HF). We aimed to ascertain whether the HFpEF-ABA score, a simple 3-variable tool to facilitate timely diagnosis of HFpEF, is associated with adverse cardiovascular (CV) outcomes in patients with CKD and T2D but without HF. Methods In this participant-level pooled analysis of the FIDELITY program, including FIDELIO-DKD and FIGARO-DKD, HFpEF-ABA scores (based on age, body mass index, and atrial fibrillation status) were calculated at baseline. Clinical outcomes and treatment effects of finerenone versus placebo were evaluated according to continuous and categorical (low/intermediate, <75%; high, ≥75%) HFpEF-ABA score among FIDELITY participants without HF. Results Among 12,990 FIDELITY participants, 11,950 (mean age, 65±10 years; 30% female; median HFpEF-ABA score, 62%[47%,77%]) had a calculable HFpEF-ABA. Among FIDELITY patients without HF, those with a high (28%) vs. low/intermediate (72%) HFpEF-ABA score had a higher rate of CV death or incident HF hospitalization (HR, 2.18; 95%CI, 1.86-2.55; P <0.001), incident HF hospitalization (HR, 2.61; 95%CI, 2.13-3.19; P <0.001), and CV death (HR, 1.79; 95%CI, 1.41-2.26; P <0.001). Finerenone reduced CV death or incident HF hospitalization irrespective of baseline HFpEF-ABA score category ( P interaction =0.68), with greater absolute benefits among those with a high (absolute rate reduction [ARR], 0.8 per 100 person-years) vs. low/intermediate (ARR, 0.2 per 100 person-years) HFpEF-ABA score. Serious adverse events were less common with finerenone vs. placebo in both HFpEF-ABA score categories. Conclusions Among persons with CKD and T2D, the HFpEF-ABA model identified increased risks of incident HF and CV death. Finerenone consistently reduced CV events across a broad HFpEF-ABA score spectrum.
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Inciardi et al. (2026) conducted a cohort in Chronic kidney disease and type 2 diabetes (n=11,950). High HFpEF-ABA score (≥75%) vs. Low/intermediate HFpEF-ABA score (<75%) was evaluated on CV death or incident HF hospitalization (HR 2.18, 95% CI 1.86-2.55, p=<0.001). A high HFpEF-ABA score was associated with an increased risk of CV death or incident HF hospitalization (HR 2.18; 95% CI 1.86-2.55; P<0.001), and finerenone reduced these events across all scores.
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