A Comprehensive Exploration of FINEARTS-HF: A JACC Theme Issue

Podcast Overview The podcast, hosted by Valentin Fuster on January 21, 2025, provides an in-depth review of the FINEARTS-HF trial, which evaluated the efficacy of the non-steroidal mineralocorticoid receptor antagonist finerenone in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The episode highlights findings published in the Journal of the American College of Cardiology (JACC). Introduction to the FINEARTS-HF Trial (00:03:19 – 00:05:56) The FINEARTS-HF trial demonstrated that finerenone reduced heart failure events by 16% compared to placebo in patients with HFmrEF/HFpEF. However, cardiovascular death rates were similar between groups, making the overall clinical impact moderate. Finerenone's Impact on Quality of Life (00:05:59 – 00:12:46) The trial assessed quality of life using the Kansas City Cardiomyopathy Questionnaire (KCCQ), revealing only a slight improvement (1.62 points) with finerenone. Critics, including the FDA, questioned the clinical relevance of these results and suggested the need for simpler, more meaningful patient-reported outcome measures. Finerenone in Patients with Recent Worsening Heart Failure (00:12:58 – 00:20:30) Patients with recent worsening heart failure showed a greater absolute benefit from finerenone, as they were at higher risk of recurrent events and cardiovascular death. However, further studies are needed to confirm these findings. Finerenone's Role in Obese Patients with HFmrEF/HFpEF (00:20:31 – 00:25:20) In obese patients, the benefits of finerenone were consistent across body mass index (BMI) categories, with a possible greater effect in those with higher BMI. Nevertheless, the reliance on BMI as a metric for obesity was criticized, and alternative measures were recommended. Finerenone and Kidney Outcomes (00:25:23 – 00:40:52) Finerenone showed a modest reduction in albuminuria but did not significantly alter kidney disease progression. Initial declines in glomerular filtration rate (GFR) were noted but should not automatically lead to discontinuation of therapy. Mixed findings highlight the need for more research to understand its renal effects. Conclusion (00:40:54 – 00:44:05) The FINEARTS-HF trial was recognized as a landmark study, showcasing modest benefits of finerenone in a challenging patient population. The podcast calls for continued research to refine quality of life metrics, better understand obesity's role in HFmrEF/HFpEF, and explore finerenone's long-term renal and cardiovascular impacts.