Orly Vardeny, PharmD, MS: Finerenone for Heart Failure with EF >40% in FINEARTS-HF

In this expert interview at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Orly Vardeny, PharmD, a professor of medicine at the University of Minnesota, discussed findings from the FINEARTS-HF trial, focusing on the efficacy and safety of finerenone, a nonsteroidal mineralocorticoid receptor antagonist (MRA), in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (EF ≥40%).

The trial enrolled patients with symptomatic HF, elevated natriuretic peptide levels, and structural heart disease. Finerenone reduced the risk of cardiovascular death and total worsening HF events compared to placebo. Vardeny indicated the drug’s pharmacologic properties, including kidney-protective effects and a lower propensity for hyperkalemia compared to steroidal MRAs, marking it as a promising treatment option. Despite a twofold increase in hyperkalemia (potassium levels ≥5.5 mmol/L) incidence (14% vs. 7% with placebo), Vardeny noted severe hyperkalemia events were rare, and finerenone also mitigated the risk of hypokalemia, a known driver of arrhythmic events.

Dr. Vardeny emphasized that FINEARTS-HF provided evidence supporting the use of finerenone in patients with HF and preserved EF, addressing a critical unmet need alongside treatment with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The trial also demonstrated improvements in patient-reported functional status, measured by the Kansas City Cardiomyopathy Questionnaire. However, Vardeny highlighted the challenge of translating trial findings into clinical practice, citing the historically slow adoption of novel therapies in the HF community. She added that future research, including real-world evidence, could further validate these findings and enhance widespread implementation to improve outcomes for this patient population.

Relevant disclosures for Vardeny include Cardior, Bayer, Moderna, and Cardurion.

Reference

Vardeny O. FINEARTS-HF - Finerenone in Heart Failure with EF > 40%. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.