Evidence map›Paper›PMID 41313540›Full record

ArticleCardiovascular drugs and therapy2026

Finerenone Versus Spironolactone for Heart Failure with Preserved Ejection Fraction.

Eiad Habib, Ramzi Ibrahim, Hoang Nhat Pham, Mahmoud Abdelnabi, Christopher Kanaan, Abdulrhman Eldeib, Silvio Nunes Augusto, Chadi Ayoub, W H Wilson Tang, Reza Arsanjani

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Cardiovascular drugs and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Review
  3. Review
  4. Review
  5. Article
  6. Obesity and Heart Failure: Introducing the Theme.Journal of cardiovascular development and disease · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Eiad HabibDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. eamhb96@hotmail.com.
Ramzi IbrahimDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Hoang Nhat PhamDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Mahmoud AbdelnabiDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Christopher KanaanDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Abdulrhman EldeibDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Silvio Nunes AugustoDepartment of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Chadi AyoubDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
W H Wilson TangDepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Reza ArsanjaniDepartment of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeMineralocorticoid receptor antagonists (MRAs) improve outcomes in patients with heart failure with preserved ejection fraction (HFpEF), yet comparative effectiveness between steroidal and nonsteroidal agents remains unknown. Our aim was to compare cardiovascular and safety outcomes associated with finerenone versus spironolactone among patients with HFpEF.

methodsThis retrospective cohort study used a global federated health research network to identify adults with new-onset HFpEF between January 1, 2021, and August 1, 2025. Propensity score matching (1:1) balanced baseline characteristics, and outcomes were assessed with Cox proportional hazards models. A total of 253 patients prescribed finerenone and 32,266 prescribed spironolactone were identified; after matching, 251 patients were retained in each cohort (mean age, 73 years; 47% female). The primary outcome was acute HF events. Secondary outcomes included all-cause hospitalizations, mortality, myocardial infarction, stroke, and a composite of major adverse cardiovascular events. Safety outcomes included acute kidney injury (AKI) and hyperkalemia.

resultsAcute HF events occurred in 6.0% of patients receiving finerenone and 4.4% receiving spironolactone (HR 1.26, 95% CI 0.58-2.74). All-cause mortality was lower with finerenone (4.4% vs. 8.0%; HR 0.48, 95% CI 0.23-1.00). Other clinical and safety outcomes, including MACE (11.6% vs. 10.8%), AKI (10.4% vs. 8.0%), and hyperkalemia (5.8% vs. 6.2%), were similar between groups.

conclusionIn this first direct comparison of MRAs in HFpEF, finerenone demonstrated broadly comparable effectiveness and safety to spironolactone. While these observations are hypothesis-generating, prospective studies are warranted to confirm these findings and inform therapeutic decision-making.

Indexed as

Heart FailureMineralocorticoid Receptor AntagonistsNaphthyridinesSpironolactoneStroke VolumeVentricular Function, LeftAgedAged, 80 and overFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomefinerenoneMineralocorticoid Receptor AntagonistsNaphthyridinesSpironolactoneFinerenoneHeart failurePreserved ejection fractionSpironolactone

Identifiers

PMID41313540

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.