Finerenone combined with guideline-directed medical therapy in patients with post-myocardial infarction heart failure: a real-world study.

OBJECTIVE

To evaluate the short-term impact of finerenone combined with guideline-directed medical therapy (GDMT) on cardiac structure, function, and renal parameters in Chinese patients with post-myocardial infarction heart failure in a real-world setting.

METHODS

In this prospective observational cohort study, 67 patients received finerenone plus optimized GDMT for 3 months. Changes were assessed using echocardiography (measuring LVEF, GLS, left atrial strain and volume index), laboratory tests (NT-proBNP, serum potassium, renal function, urinary albumin-to-creatinine ratio [UACR]), and functional assessments (6-min walk test, Minnesota Living with Heart Failure Questionnaire).

RESULTS

Treatment significantly improved cardiac function and structure. LVEF increased from 49 (2)% to 53 (2)% (P < 0.001), GLS improved from 14 (1)% to 16 (1)% (P < 0.001), and left atrial reservoir strain increased from 27 (2)% to 32 (2)% (P < 0.001). Structural reverse remodeling was evidenced by reduced left ventricular end-diastolic diameter (54.85 [1.08] to 52.85 [0.96] mm, P < 0.001) and left atrial volume index (38.78 [2.69] to 36.25 [2.61] mL/m2, P < 0.001). Concurrently, a significant reduction in UACR was observed from 3.41 ± 1.52 mg/g to 2.76 ± 0.90 mg/g (P < 0.001). Clinically, NT-proBNP decreased from 1,249 ± 1,251 to 431 ± 319 pg/mL (P < 0.001), 6-min walk distance increased by 41.11 m (P < 0.001), and quality of life scores improved (a reduction of 11.59 points, P < 0.001). Serum potassium and renal function (serum creatinine) remained stable.

CONCLUSION

In this real-world cohort of 67 post-myocardial infarction heart failure patients, adding finerenone to GDMT for 3 months was associated with significant improvements in cardiac structure and function, a reduction in UACR, and better functional capacity and quality of life. Nevertheless, due to the single-arm design, these findings are exploratory and hypothesis-generating.