Clinical outcomes and safety of finerenone in patients with heart failure: a real-world observational study in China

Objective Finerenone is a highly selective nonsteroidal mineralocorticoid receptor antagonist, but data on its use in patients with heart failure (HF) in real-world clinical practice remain limited. This study evaluated longitudinal clinical changes and safety outcomes observed during finerenone treatment in patients with HF. Methods This single-center, retrospective observational study included consecutive patients diagnosed with HF and treated with add-on finerenone between August 2023 and May 2024 at Tongji Hospital, Shanghai, China. All patients received finerenone add-on to standard treatment. Subgroup analyses were performed in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF). Adverse events were recorded, including HF readmission, outpatient visits for acute HF, and diuretic dosage escalation. Laboratory and cardiac function markers were also collected. Results Seventy-three patients were included. Favorable longitudinal changes were observed in cardiac structure, diastolic function, biomarker levels, and symptom status during follow-up. Left atrial diameter decreased from 50 to 48 mm, the E/e’ ratio decreased from 10.65 to 8.20, and NT-proBNP decreased by 67.47% at 12 months ( P < 0.001). NYHA functional class distribution also shifted toward lower symptom burden over time, and LVEF showed a modest increase. No patients discontinued finerenone because of adverse events. Conclusion In real-world clinical practice, finerenone was associated with a favorable clinical and safety profile in patients with HF, with profiles similar across the HFrEF, HFmrEF, and HFpEF subgroups. Future larger-sample, multicenter randomized controlled trials are warranted to validate these observations.