Q&A: Finerenone Lowers Heart Failure Events in Patients With or Without Ischemic Heart Disease, With Jawad Butt, MD, PhD

Patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), the beneficial effects of finerenone were consistent regardless of ischemic heart disease (IHD) status, according to a prespecified analysis of the FINEARTS-HF trial. These data were presented at the American College of Cardiology (ACC) Scientific Sessions 2026 in New Orleans, Louisiana, by Jawad Butt, MD, PhD, a research fellow in the department of cardiology at Copenhagen University Hospital and the University of Glasgow.¹

The trial evaluated the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone in patients with HFmrEF or HFpEF. In the main study, finerenone significantly reduced total heart failure events and cardiovascular death compared with placebo and was safe and well tolerated. The new analysis specifically examined outcomes in patients with and without a history of IHD, who comprised 43% of the trial population.

For primary care physicians, these findings are clinically relevant on several fronts. They suggest that finerenone can be considered for appropriate patients with HFmrEF or HFpEF without the need to stratify therapy based on ischemic history, potentially simplifying treatment decisions in a heterogeneous and high-risk group. Moreover, emerging data indicate that finerenone remains effective and safe even when used alongside SGLT2 inhibitors, further broadening its potential role in contemporary heart failure management.

In the following Q&A, Dr Butt discusses the new data, the implications of the ischemic versus nonischemic analysis, and how finerenone may fit into evolving guideline-directed care for HFmrEF and HFpEF in everyday clinical practice.

Q: Can you briefly describe the study and its main findings?

A: This was a prespecified secondary analysis of the FINEARTS-HF trial, a randomized, double-blind, placebo-controlled study in patients with heart failure and a mildly reduced or preserved ejection fraction. The trial evaluated the efficacy and safety of the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone.

In the main trial, finerenone:

• Significantly reduced the risk of the primary outcome (total heart failure events and cardiovascular deaths) compared with placebo.
• Was found to be safe and well tolerated versus placebo.

In this secondary analysis, we focused on the effects and safety of finerenone in patients with and without IHD. The key finding was that IHD did not modify the beneficial effects of finerenone: it reduced total heart failure events and cardiovascular death in both groups and remained safe and well tolerated, regardless of ischemic history.

Q: Why did you specifically look at patients with and without IHD?

A: IHD is a very common comorbidity in patients with heart failure and a mildly reduced or preserved ejection fraction, and we confirmed this in the FINEARTS-HF trial. About 43% of patients enrolled had a history of IHD.

We also found that a history of IHD was significantly associated with an increased risk of:

• All-cause death
• Cardiovascular death
• Total worsening heart failure events

So it’s both common and associated with worse outcomes. For clinicians, managing heart failure with a mildly reduced or preserved ejection fraction is already complex, and IHD is frequently present in the patients we see every day.

The main take-home message is that finerenone is an important treatment because it simplifies clinical decision-making:
clinicians do not need to differentiate between patients who do and do not have a history of IHD when deciding whether to use finerenone.

Q: How does the role of IHD differ between heart failure with reduced versus preserved ejection fraction?

A: In heart failure with reduced ejection fraction (HFrEF), the predominant etiology is often IHD.

In contrast, in patients with heart failure with a mildly reduced or preserved ejection fraction, the underlying etiology is not often IHD, although IHD still remains a very common comorbidity.

Our findings—showing similar efficacy and safety of finerenone in patients with and without IHD—underscore the importance of this treatment and again highlight that it makes clinical decision-making easier for clinicians across this heterogeneous patient group.

Q: What has the treatment landscape looked like historically for heart failure with mildly reduced or preserved ejection fraction, and where does finerenone fit now?

A: Historically, for patients with heart failure with a mildly reduced or preserved ejection fraction, we had no effective treatments until very recently.

• The first major advance was the approval of SGLT2 inhibitors, which were shown to be effective in this population.
• More recently, the FDA approved finerenone, a non-steroidal MRA, for the treatment and management of these patients.

We have conducted several analyses, including one examining the efficacy and safety of finerenone on top of SGLT2 inhibitors. We found that finerenone is effective and safe even in patients already receiving SGLT2 inhibitors.

Based on these data, I strongly believe finerenone will gain a clear place in international guidelines for the management of heart failure with a mildly reduced or preserved ejection fraction.

Q: What is the key clinical takeaway for practicing clinicians?

A: For clinicians seeing these patients in everyday practice, the key messages are:

• IHD is common in this population and is associated with substantially worse outcomes.
• Finerenone reduces heart failure events and cardiovascular death and is safe, regardless of IHD history.
• Clinicians do not need to stratify patients by ischemic status when considering finerenone, which simplifies treatment decisions in an already complex patient group.

Combined with SGLT2 inhibitors, finerenone represents an important evidence-based option that is likely to be reflected in future guidelines and can meaningfully improve outcomes in patients with heart failure and a mildly reduced or preserved ejection fraction.

Editors’ Note: Butt reports disclosures with AstraZeneca, Bayer, and Novartis.

References:

1. Butt J, Jhund P, Henderson A, et al. Ischemic Heart Disease Does Not Modify the Beneficial Effects of Finerenone in HFmrEF/HFpEF: A Prespecified Analysis of the FINEARTS-HF Trial. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.
2. Bayer. Study to Evaluate the Efficacy (Effect on Disease) and Safety of Finerenone in Participants With Heart Failure and Left Ventricular Ejection Fraction (Proportion of Blood Expelled per Heart Stroke) Greater or Equal to 40% (FINEARTS-HF). ClinicalTrials.gov Identifier: NCT04435626. Updated August 26, 2025. Accessed April 7, 2026. https://clinicaltrials.gov/study/NCT04435626