ESC Congress 2026 Abstract · Oct 26, 2026
Cardiovascular-kidney-metabolic overlap and finerenone in heart failure: insights from the FINEARTS-HF Trial
By Ostrominski J, Claggett BL, Desai AS et al.
Background: Cardiovascular-kidney-metabolic (CKM) multimorbidity is common in heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and contributes to adverse outcomes. However, whether the extent of CKM overlap in HF modifies the benefits or safety profile of finerenone in this population has not been rigorously evaluated. Purpose: To evaluate clinical outcomes and treatment effects of finerenone according to the number and type of concomitant CKM components among FINEARTS-HF trial participants. Methods: In this prespecified analysis of the FINEARTS-HF trial, cardiovascular disease (CVD) was defined as history of atherosclerotic cardiovascular disease or atrial fibrillation/flutter (per medical history or baseline electrocardiography). Chronic kidney disease (CKD) was defined as either a history of CKD, a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2, or a baseline urine albumin-to-creatinine ratio ≥30 mg/g. Metabolic disease was defined as either obesity (elevated body mass index or waist-to-height ratio ≥0.5), type 2 diabetes (history of type 2 diabetes or baseline glycated hemoglobin ≥6.5%), or history of metabolic dysfunction-associated steatotic liver disease. Treatment effects of finerenone were examined according to CKM status. Results: Among 6,001 participants, 5,977 (99.6%) had one or more concomitant CKM components; 619 (10.3%) had 0-1 overlapping CKM components, 2,170 (36.2%) had 2 overlapping CKM components, and 3,212 (53.5%) had 3 overlapping CKM components (Figure 1A). Participants with greater CKM overlap at baseline tended to be older and male, and had higher degrees of myocardial injury (troponin levels) and worse health status (KCCQ). When compared with participants with 0-1 CKM components, those with 2 (adjusted rate ratio [aRR], 1.32; 95% CI, 1.02-1.72) and 3 (aRR, 2.58; 95% CI, 2.01-3.32) CKM components experienced an incrementally higher rate of the primary composite outcome of cardiovascular death and total HF events over a median follow-up of 2.7 [1.9, 3.0] years (Ptrend<0.001) (Figure 1B). Similar findings were observed when the number of unique CKM conditions was examined (Figure 1C-D). Benefits of finerenone on cardiovascular death and total HF events appeared consistent irrespective of the number of CKM components (Pinteraction=0.09) and CKM conditions (Pinteraction=0.35) at baseline. Risks of adverse events leading to treatment discontinuation were not enhanced with finerenone vs. placebo among participants with greater CKM multimorbidity. Conclusions: In this analysis, we identified CKM multimorbidity in nearly all FINEARTS-HF trial participants, and the efficacy and safety profiles of finerenone did not appear to be modified by baseline CKM status. These findings underscore the importance of systematic identification and management of CKM conditions in persons with HFmrEF/HFpEF.