Finerenone Reduces Clinical Events in Patients With Heart Failure Regardless of CHD History

Coronary heart disease (CHD) is one of the most common comorbidities in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), yet its prognostic and therapeutic implications in this population have remained incompletely characterized.¹

A prespecified analysis of the landmark FINEARTS-HF (NCT04435626) trial sheds new light on how CHD history shapes patient risk and confirms that the mineralocorticoid receptor antagonist finerenone (Kerendia; Bayer) delivers consistent clinical benefit regardless of whether patients carry that history.

CHD is among the most common causes of HF, occurring when the arteries supplying blood to the heart muscle narrow and force the heart to work harder to pump blood, a strain that can progressively weaken its pumping ability over time.² Characterized by atherosclerosis, or the buildup of fatty deposits along the inner lining of the coronary arteries, CHD can decrease or block blood flow to the heart entirely.

When the damaged arteries become completely blocked or prone to clotting, the result can be a heart attack, an event that leaves behind scar tissue and further compromises cardiac function. For patients with HFmrEF or HFpEF, who already face impaired ventricular filling and elevated filling pressures, the added burden of coronary disease creates a compounded risk profile that clinicians must actively address alongside heart failure-directed therapies.

Of the 6001 patients enrolled in the trial, 53.9% had an investigator-reported history of CHD.¹ These patients were meaningfully different from their non-CHD counterparts at baseline. They were slightly younger (mean age, 71 vs 73), more likely to be male (63% vs 44%), had higher rates of peripheral arterial occlusive disease (12% vs 5%), type 2 diabetes (47% vs 34%), and loop diuretic use (86% vs 88%), and were more frequently on antiplatelet agents (59% vs 15%) and anticoagulants (42% vs 63%). The CHD cohort also had higher N-terminal pro-B-type natriuretic peptide levels at baseline (median, 912 vs 1,181 pg/mL), reflecting a distinct risk profile compared with the non-CHD group.

Clinically, a CHD history translated into substantially worse outcomes. Patients with CHD experienced higher rates of cardiovascular death and total HF events, with 1414 events in that group compared with 952 in those without CHD. Cardiovascular death occurred in 10.1% of patients with CHD vs 6.3% without CHD, and first stroke, myocardial infarction (MI), or cardiovascular death was nearly twice as common (15.9% vs 8.9%). The rate ratio (RR) for fatal or non-fatal stroke or MI was 2.26 (95% CI, 1.75-2.93) in patients with CHD, underscoring the substantially elevated atherothrombotic burden in this subgroup.

Despite these differences in baseline risk, finerenone demonstrated consistent benefit on the primary composite outcome in both patients with (RR, 0.86; 95% CI, 0.73-1.01) and without CHD (RR, 0.8; 95% CI, 0.67-0.99), with a non-significant interaction P-value of 0.68. A similar pattern was observed for total HF events (interaction P = .90) and all-cause death (interaction P = .77), reinforcing the drug's consistent efficacy signal across a clinically heterogeneous population.

Importantly, finerenone did not meaningfully reduce the risk of first stroke, MI, or cardiovascular death (RR, 0.96 [no CHD] and 1.09 [CHD]) or fatal/non-fatal stroke or MI (RR, 1.10 [no CHD] and 1.16 [CHD]). The interaction P-values for these atherothrombotic end points (0.39 and 0.80, respectively) similarly indicated no differential effect by CHD status.

References

1. Butt JH, Jhund PS, Henderson AD, et al. Finerenone, coronary heart disease, and heart failure with mildly reduced or preserved ejection fraction: a prespecified analysis of the FINEARTS-HF trial. Presented at: American College of Cardiology Annual Scientific Session; March 28-30, 2026; New Orleans, LA.

2. Heart failure. Johns Hopkins Medicine. Accessed April 10, 2026. https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-failure