The safety and efficacy of finerenone in patients with HFmrEF/HFpEF receiving background diuretics remained uncertain. A prespecified secondary analysis of the FINEARTS-HF trial, published in JAMA Cardiology, evaluated outcomes by diuretic use and tested whether finerenone provided a diuretic-sparing effect.

The trial enrolled 5,438 patients (mean age 72 years; 45.9% female) across 653 sites in 37 countries. Participants were stratified into diuretic categories: non-loop diuretics only, loop diuretics at ≤40 mg or >40 mg furosemide equivalent, and combined loop plus non-loop diuretics. Compared with the placebo, finerenone consistently lowered the primary endpoint of total heart failure events and cardiovascular death across all subgroups, with rate ratios ranging from 0.84 in the non-loop group to 0.54 in the combined group (P for interaction = 0.18).

Finerenone also lowered the loop diuretic dose and reduced the need for dose intensification, although it did not prevent the initiation of new loop diuretics. Safety remained consistent across all baseline diuretic categories. These findings confirm the diuretic-sparing potential of finerenone in HFmrEF/HFpEF while maintaining cardiovascular protection.