Real-world study of finerenone in patients with heart failure with preserved ejection fraction in Spain

PURPOSE: To evaluate the effects of finerenone in patients with Heart failure with preserved ejection fraction (HFpEF), diabetes, chronic kidney disease, and albuminuria in Spain. METHODS: This observational, retrospective multicenter study included adults with HFpEF, type 2 diabetes, chronic kidney disease, and albuminuria who started finerenone between June 1, 2024, and January 1, 2025. The patients were monitored over a six-month period. Hyperkalemia was defined as a serum potassium level > 5.5 mEq/L, and renal function deterioration as a > 25% decrease in baseline estimated glomerular filtration rate. RESULTS: The study included 96 participants with a median age [IQR] of 78.50 [74.00, 83.00] years; 64.4% were male. Hypertension was present in 88.5% of subjects, type 2 diabetes in 94.8%, and ischemic heart disease in 32.3%. Regarding treatments, 93.8% of patients were prescribed SGLT2 inhibitors, 59.4% renin-angiotensin system inhibitors, and 64.6% beta blockers. During follow-up, significant improvements in NYHA functional class and albuminuria were observed, together with a trend toward lower natriuretic peptide levels. There was no significant change in systolic blood pressure or glomerular filtration rate. At study end, 5.2% of patients died, 8.3% had a hospitalization related to HF, 13.5% discontinued finerenone, 5.2% experienced symptomatic hypotension, 10.4% developed hyperkalemia, and 16.7% showed a decline in renal function (>50%: 4.2%). CONCLUSIONS: In Spanish clinical practice, finerenone appears safe and is associated with improvements in functional class and albuminuria in patients with HFpEF, type 2 diabetes, CKD, and albuminuria.