The FINO-HF Trial: A Randomised Comparison of Finerenone Versus Spironolactone in Patients with Heart Failure with Reduced Ejection Fraction - Biomarker and Clinical Outcomes

Presenter: R Rascon Sabido

Mineralocorticoid receptor antagonists improve outcomes in HFrEF, but spironolactone is associated with hormone-related adverse effects and higher rates of hyperkalaemia. The FINO-HF trial therefore compared finerenone with spironolactone in 500 patients with chronic HFrEF (LVEF 40%, ≤NYHA class II-III) receiving stable guideline-directed therapy. Patients were randomised 2:1 to spironolactone (n=334) or finerenone (n=166) and followed for 3 months. The composite of heart failure hospitalisation or cardiovascular death occurred in 13.2% versus 8.4%, respectively (HR: 0.64; 95% CI 0.43–0.95; p=0.03), while heart failure hospitalisation was 10.2% versus 6.0% (p=0.02). Cardiovascular mortality was 4.5% versus 2.4% (HR: 0.53; 95% CI 0.28–0.99; p=0.048). Finerenone also produced greater NT-proBNP reduction (-43% vs. -31%; p=0.004) and fewer hyperkalaemia, worsening renal function, gynaecomastia, and adverse-event discontinuations.

Optimizing Mineralocorticoid Receptor Antagonist Therapy with Sodium Zirconium Cyclosilicate in Heart Failure

Presenter: C Basic

Hyperkalaemia remains a major barrier to optimal mineralocorticoid receptor antagonist (MRA) therapy in HFrEF, contributing to their underuse despite established morbidity and mortality benefits. The investigator-initiated, multicentre, randomized, placebo-controlled, double-blinded OPRA-HF trial assessed whether sodium zirconium cyclosilicate (SZC) could facilitate MRA optimization in patients at high risk of hyperkalaemia. Among 123 screened patients, 103 entered the run-in phase (age 74,0± 7,8 years, male 81,6%, LVEF 31,2 ±6,9%), with 58 subsequently randomized. At 6 months, 67,9% receiving SZC maintained the optimized MRA dose with S-K 3,5-5,0 mmol/L versus 24,1% with placebo (RR 2,81 [1,18-6,69]; OR 6.63 [2.07-21.23]; p=0.0014). MRA dose maintenance was achieved in 78,6% versus 41,4% (RR 1,90 [0,94-3,84], p=0,0067). SZC was well tolerated, with worsening HF events in 3,6% versus 6,7% (p=1.0). Overall, SZC enabled greater maintenance of optimized MRA therapy without an apparent increase in HF events.

Cardiovascular-Kidney-Metabolic Overlap and Finerenone in Heart Failure: Insights from the FINEARTS-HF Trial

Presenter: J Ostrominski

Cardiovascular-kidney-metabolic (CKM) multimorbidity was present in nearly all participants of FINEARTS-HF, with greater overlap associated with progressively higher rates of cardiovascular death and total heart failure (HF) events. This prespecified analysis assessed whether the number and type of CKM components influenced outcomes and the efficacy or safety of finerenone in HF with mildly reduced or preserved ejection fraction. Among 6,001 participants, 5,977 (99.6%) had ≥1 CKM component; 619 (10.3%) had 0-1, 2,170 (36.2%) had 2, and 3,212 (53.5%) had 3 components. Over a median follow-up of 2.7 [1.9, 3.0] years, compared with 0-1 components, 2 and 3 components were associated with higher rates of the primary outcome (aRR, 1.32; 95% CI, 1.02-1.72 and aRR, 2.58; 95% CI, 2.01-3.32; Ptrend<0.001). Finerenone’s benefits appeared consistent across CKM burden (Pinteraction=0.09) and conditions (Pinteraction=0.35), without increased discontinuation-related adverse events.

FINE-FUNCTION HF: Finerenone and FUNCTIONal Capacity in Heart Failure after Switching from Spironolactone to Finerenone

Presenter: AKE Freitas

Short-term changes in functional performance and patient-reported health status after therapeutic optimization remain insufficiently characterized in HFpEF/HFmrEF. This prospective, single-centre study evaluated 30-day changes after switching from spironolactone to finerenone in 53 patients (mean age 71.8 ± 1.3 years; 45.3% male; mean LVEF 57.8 ± 1.3%). Objective functional capacity, assessed by the 6-minute walk test (6MWT), increased from 263.6 ± 12.9 m to 302.0 ± 11.4 m (Δ +38.4 m; 95% CI 15.9–41.4; p<0.001; Cohen’s d = 0.64). KCCQ total score also improved from 48.5 ± 3.5 to 67.1 ± 3.5 (Δ +18.7; p<0.001), with gains across physical limitation and symptom domains (all p<0.001). Changes in 6MWT and KCCQ were not correlated, while lower baseline KCCQ scores were associated with greater improvement (ρ = −0.437; p = 0.002). Renal function and potassium remained unchanged, with no clinically relevant hyperkalaemia or treatment discontinuations due to adverse events.

ESC Congress 2026, 28 - 31 Aug, Munich, Germany