Finerenone in heart failure with ejection fraction ≥40%: state of the art and future perspectives.

Heart failure with ejection fraction ≥40% is associated with high mortality and risk of decompensation, as well as poorer quality of life. SGLT2 inhibitors are currently considered the standard therapy for these patients. However, despite treatment with these drugs, patients continue to have a high risk of adverse events. Overactivation of the mineralocorticoid receptor promotes the release of inflammatory and profibrotic factors, which contribute to the development and progression of this entity. However, not all mineralocorticoid receptor antagonists have demonstrated clinical benefit in these patients. The FINEARTS-HF study demonstrated that finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly reduces the risk of cardiovascular death or heart failure decompensation, with consistent results across all patient subgroups analyzed. Consequently, in the treatment of these patients the combination of SGLT2 inhibitors and finerenone should be considered.