Finerenone showed lower risks of hospitalization and mortality than spironolactone in adults with HFpEF. The study in Circulation compared clinical outcomes between finerenone and spironolactone using real-world electronic health record data.

The retrospective cohort used the TriNetX network across 101 organizations. The analysis included 809 finerenone users and 179,566 spironolactone users before matching. After 1:1 propensity matching, each group included 796 patients. Patients with systolic heart failure were excluded to ensure a pure HFpEF population. Outcomes were assessed over 12 months.

Finerenone showed lower hospitalization rates at 30.0% vs 42.1%, while mortality was 3.8% vs 11.9%, producing a risk difference of –8.1% (95% CI –10.7% to –5.5%). Acute kidney injury occurred in 22.0% vs 28.3% (odds ratio [OR] 0.715), and hyperkalemia occurred in 9.4% vs 15.5% (OR 0.569). One-year survival curves favored finerenone, with a mortality hazard ratio of 0.358 (95% CI 0.237–0.540).

Finerenone showed lower hospitalization and mortality compared with spironolactone, suggesting a safer and potentially more effective option for HFpEF. Prospective studies are needed to confirm these findings.