Heart failure with preserved or mildly reduced ejection fraction (LVEF 40% or above) has long lacked disease-modifying options beyond SGLT2 inhibitors. FINEARTS-HF adds a second evidence-based pillar: the nonsteroidal mineralocorticoid receptor antagonist finerenone.
Key result. In patients with symptomatic HF and LVEF at or above 40%, finerenone reduced the composite of total worsening heart-failure events (hospitalisations and urgent HF visits) plus cardiovascular death versus placebo, an approximately 16% relative reduction, with benefit broadly consistent across the ejection-fraction range studied. As with any MRA, monitor potassium and renal function; the nonsteroidal agent has a different profile from steroidal MRAs.
Where it fits. SGLT2 inhibitors remain the class with the most consistent HFpEF outcome data; finerenone now offers an additional option. Ongoing trials (combination and phenotype-specific designs such as REDEFINE-HF, CONFIRMATION-HF and FINALITY-HF) are clarifying sequencing with SGLT2 inhibitors, while GLP-1 receptor agonists such as semaglutide (STEP-HFpEF) address symptoms and function in obese HFpEF.
Why it matters for central Gujarat. HFpEF is common in older patients with hypertension, diabetes and obesity, a large slice of our clinic population that has historically had few proven therapies. A finerenone option, alongside SGLT2 inhibitors and risk-factor control, broadens what we can offer, provided potassium and renal function are monitored.