ArticleESC heart failure2026
Finerenone vs spironolactone in heart failure with mildly reduced or preserved ejection fraction: a real-world study.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
aimsFinerenone has shown benefit in chronic kidney disease, type 2 diabetes, and heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), but head-to-head data against spironolactone are limited. We compared 12-month effectiveness and safety after finerenone vs spironolactone initiation in heart failure with left ventricular ejection fraction ≥40%. METHODS AND
resultsWe conducted a retrospective active-comparator, new-user cohort study using the TriNetX Network from 9 July 2021 to 31 March 2025. Adults of both sexes with HFmrEF/HFpEF initiating finerenone or spironolactone were matched 1:1 by propensity score. The primary outcome was all-cause mortality or heart failure exacerbation. Secondary outcomes included all-cause mortality, heart failure exacerbation, all-cause hospitalization, and acute myocardial infarction; safety outcomes were hyperkalaemia and acute kidney injury. After matching, 1417 patients were included in each group. Finerenone initiation was associated with lower risk of the primary outcome (32.3% vs 41.7%; adjusted hazard ratio [aHR] 0.72, 95% confidence interval [CI] 0.64-0.82; P < .001). Lower risks were also observed for all-cause mortality (aHR 0.67, 95% CI 0.51-0.87), heart failure exacerbation (aHR 0.73, 95% CI 0.64-0.83), and all-cause hospitalization (aHR 0.83, 95% CI 0.76-0.91), but not acute myocardial infarction. Hyperkalaemia was less frequent with finerenone (17.9% vs. 22.8%; risk ratio 0.79, 95% CI 0.68-0.91); acute kidney injury showed only a borderline difference.
conclusionsFinerenone initiation was associated with lower 12-month clinical event and hyperkalaemia risks than spironolactone initiation. These observational associations should be considered hypothesis-generating and require confirmation in randomized head-to-head trials.
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