Finerenone, chronic obstructive pulmonary disease, and heart failure with mildly reduced or preserved ejection fraction: A prespecified analysis of the FINEARTS-HF trial

Aims: Chronic obstructive pulmonary disease (COPD) is associated with worse outcomes in heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). A post hoc analysis of TOPCAT suggested that the effectiveness of the steroidal mineralocorticoid receptor antagonist (MRA), spironolactone, may be modified by pulmonary disease, with a greater benefit in patients with COPD/asthma. We examined the effects of the non-steroidal MRA, finerenone, compared to placebo, according to COPD status in a prespecified analysis of FINEARTS-HF. Methods and results: A history of COPD was investigator-reported. The primary outcome was the composite of cardiovascular death and total worsening HF events. Of the 6001 patients randomized in FINEARTS-HF, 773 patients (12.9%) had COPD. Compared to patients without COPD, those with COPD had more adverse clinical features, including worse New York Heart Association class and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, more prior HF hospitalization, atrial fibrillation/flutter, obesity, peripheral artery disease, and hypertension, as well as elevated high-sensitivity troponin T levels. Patients with COPD had a higher risk of the primary endpoint (adjusted rate ratio [RR] 1.44, 95% confidence interval [CI] 1.21–1.71). The benefit of finerenone on the primary outcome was consistent irrespective of COPD status (no COPD: RR 0.84 [95% CI 0.73–0.97]; COPD: 0.84 [95% CI 0.61–1.16]; pinteraction = 0.93). Consistent effects were also observed for all secondary outcomes. Finerenone improved KCCQ total symptom score from baseline to 12 months to a similar extent in patients with and without COPD (pinteraction = 0.46). Conclusion: In patients with HFmrEF/HFpEF, the beneficial effects of finerenone on clinical events and symptoms were consistent, regardless of COPD status. Clinical Trial Registration: ClinicalTrials.gov ID NCT04435626.