Anaemia in patients with heart failure and mildly reduced or preserved ejection fraction: A prespecified analysis of the FINEARTS-HF trial

Aims Anaemia is common in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and associated with poor clinical outcomes. While renin-angiotensin system blockers reduce haemoglobin, little is known about the effect of mineralocorticoid receptor antagonists on haemoglobin and in patients with anaemia. We evaluated the effects of finerenone according to anaemia status in patients with HFmrEF/HFpEF enrolled in FINEARTS-HF. Additionally, we examined the effect of finerenone on haemoglobin, new-onset anaemia, and resolution of anaemia during follow-up. Methods and results Anaemia was defined as haemoglobin <12 g/dl in women and <13 g/dl in men. The primary outcome was the composite of total (first and recurrent) heart failure events and cardiovascular death. Of 5665 patients analysed, 1584 (28.0%) had anaemia at baseline. Patients with anaemia were at higher risk of the primary endpoint compared to those without anaemia: event rate 24.3 (95% confidence interval [CI] 21.9-26.9) versus 13.1 (95% CI 12.0-14.3) per 100 person-years; rate ratio [RR] 1.67 (95% CI 1.45-1.92). Persistence of anaemia was associated with worse outcomes compared to resolution of anaemia, and patients with new-onset anaemia had worse outcomes than those who did not develop anaemia. The effect of finerenone on the primary endpoint was consistent in patients with and without anaemia (RR 0.89; 95% CI 0.73-1.10 vs. RR 0.76; 95% CI 0.64-0.91; interaction p = 0.27) and across the range of haemoglobin at baseline. Finerenone treatment did not increase the resolution of anaemia or prevent new-onset anaemia. Conclusions Finerenone reduces the risk of clinical outcomes regardless of anaemia status. Clinical Trial Registration ClinicalTrials.gov NCT04435626.