Finerenone Reduces New-Onset Atrial Fibrillation Across the Spectrum of Cardio-Kidney-Metabolic Syndrome: The FINE-HEART Pooled Analysis.
In the FINE-HEART pooled analysis of more than 14,500 trial participants, the nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of new-onset atrial fibrillation or flutter by 17%, with consistent benefit across the cardio-kidney-metabolic spectrum.
Background
Mineralocorticoid receptor antagonists modulate cardiac and systemic pathways such as fibrosis and inflammation that may contribute to the onset of atrial fibrillation (AF) or atrial flutter (AFL). The FINE-HEART analysis evaluated whether the nonsteroidal MRA finerenone reduces incident AF/AFL across patients spanning chronic kidney disease, type 2 diabetes, and heart failure.
Study design
This prespecified participant-level pooled analysis combined three large randomized trials—FIDELIO-DKD and FIGARO-DKD (chronic kidney disease with type 2 diabetes) and FINEARTS-HF (heart failure with mildly reduced or preserved ejection fraction). Among 14,581 patients free of AF/AFL at enrollment, new-onset AF/AFL was prospectively adjudicated by blinded event committees, and risk was assessed with Cox models stratified by region and trial.
Key findings
Over a median 2.9 years of follow-up, new-onset AF/AFL occurred in 286 of patients (3.9%) on finerenone versus 345 (4.7%) on placebo (hazard ratio 0.83; 95% CI 0.71–0.97; P = 0.019). Risk reductions were consistent regardless of the number of cardio-kidney-metabolic conditions and across the individual trials. Patients who developed new-onset AF/AFL faced significantly higher subsequent risks of cardiovascular death, heart-failure hospitalization, and adverse kidney outcomes.
Clinical implications
By lowering the incidence of a clinically consequential arrhythmia across a broad cardio-kidney-metabolic population, finerenone adds an antiarrhythmic dimension to its established cardiovascular and kidney benefits. Because incident AF/AFL marked patients at higher risk of downstream cardiovascular and renal events, preventing it may carry prognostic value beyond rhythm control alone.
Category
Research
Source
J Am Coll Cardiol
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