Finerenone: from evidence to clinical practice. Data from the finerlife registry (finerenone in real life)

Introduction

Spironolactone and eplerenone have shown clear benefits in heart failure (HF) with reduced left ventricular ejection fraction (LVEF), while evidence in HF with mildly reduced or preserved LVEF has remained inconclusive. Following the FINEARTS-HF trial, finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), has emerged as a novel therapeutic option for patients with HF and LVEF ≥40%. This study aimed to evaluate the effectiveness and safety of finerenone in real-world clinical practice.

Methods

This was a prospective, single-centre, observational study including patients treated with finerenone in a specialised heart failure unit. Data collected comprised demographic characteristics, comorbidities, functional status, HF aetiology, laboratory and echocardiographic parameters, background therapy and adverse events. A descriptive analysis was performed for the entire cohort. Patients with six months of follow-up were analysed separately, comparing baseline and six-month values using the Wilcoxon signed-rank test with available paired data.

Results

Ninety-three patients were included (mean age 80.8 ± 8.9 years; 51.6% male). Hypertension (97.8%), dyslipidaemia (88.2%) and atrial fibrillation (72.0%) were the most frequent comorbidities. Median Barthel Index was 90. HF was predominantly hypertensive (71.9%), with a median LVEF of 59.5%. Most patients were in NYHA class II (83.7%), and 74.2% had a previous HF hospitalisation. SGLT2 inhibitors were prescribed in 88.2%, and 21.5% were switched from a steroidal MRA to finerenone. The initial dose was 10 mg in 80.6%.

Seventy-three patients completed six months of treatment. Median NT-proBNP levels significantly decreased (1951 vs 1287 pg/mL; p=0.003), as did CA 12.5 (20.0 vs 16.8 U/mL; p=0.024). A non-significant reduction in the albumin-to-creatinine ratio was observed (126.1 vs 92.6 mg/g; p=0.11). These changes were accompanied by a modest decline in estimated glomerular filtration rate (48.1 vs 42.3 mL/min/1.73 m²; p=0.002) and an increase in serum potassium (4.42 vs 5.15 mEq/L; p<0.002), without significant changes in systolic blood pressure. No relevant changes were observed in NYHA class or loop diuretic dose, while HF-related hospitalisations were significantly reduced (0.44 vs 0.16; p<0.001). Nineteen patients discontinued treatment, mainly due to renal function deterioration and/or hyperkalaemia.

Discussion & Conclusions

Compared with FINEARTS-HF, patients in the FineRLife registry were older, more comorbid and had poorer baseline renal function, reflecting a more complex real-world population. In this setting, finerenone was associated with improvements in congestion biomarkers and a reduction in HF hospitalisations, with an acceptable safety profile. Finerenone appears to be a promising therapeutic option for HF with mildly reduced or preserved LVEF in routine practice. Further long-term studies are needed to confirm its role as a disease-modifying therapy.For image description, please refer to the figure legend and surrounding text.Table 2.Comorbidities and treatmentFor image description, please refer to the figure legend and surrounding text.