Finerenone and New York Heart Association Functional Class in Heart Failure: The FINEARTS-HF Trial (Heart Failure January 2026)-Article: Finerenone and New York Heart Association Functional Class in Heart Failure: The FINEARTS-HF Trial

Pdf Summary

This prespecified analysis of the FINEARTS-HF trial examined whether finerenone’s benefits in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) differed by baseline New York Heart Association (NYHA) functional class. Among 6,000 participants, 69% were NYHA class II and 31% were class III/IV.<br /><br />Patients with class III/IV had a worse baseline clinical profile: they were older, more often female, had more recent heart failure events, more comorbidities, worse kidney function, higher natriuretic peptide levels, and poorer symptom scores than those with class II. They also had significantly higher rates of cardiovascular death and total heart failure events during follow-up.<br /><br />Finerenone reduced the primary outcome of cardiovascular death and total heart failure events regardless of NYHA class, with no evidence that treatment effect differed between groups. Relative benefit was similar in class II and III/IV, but absolute benefit was larger in class III/IV because their baseline risk was higher. Finerenone also improved patient-reported health status on the Kansas City Cardiomyopathy Questionnaire to a similar degree in both NYHA groups.<br /><br />However, finerenone did not significantly improve clinician-assigned NYHA functional class over 12 months. Safety findings were reassuring: the higher-risk adverse effects associated with finerenone, such as hyperkalemia, elevated creatinine, and low blood pressure, were not worse in class III/IV than in class II.<br /><br />Overall, the study supports finerenone use in symptomatic HFmrEF/HFpEF patients regardless of NYHA functional class, including those with more advanced symptoms, with a favorable balance of benefit and risk.

Meta Tag

Concept Finerenone

Concept NYHA Functional Class

Concept Heart Failure with Mildly Reduced Ejection Fraction

Concept Preserved Ejection Fraction

Concept FINEARTS-HF Trial

Keywords

finerenone

FINEARTS-HF

heart failure

HFmrEF

HFpEF

NYHA class

cardiovascular death

hyperkalemia

Kansas City Cardiomyopathy Questionnaire

symptomatic patients

Finerenone

NYHA Functional Class

Heart Failure with Mildly Reduced Ejection Fraction

Preserved Ejection Fraction

FINEARTS-HF Trial