Risk Model Validates Finerenone Effect in Heart Failure

METHODOLOGY:

Researchers validated the performance of the PREDICT-HFpEF tool in the FINEARTS-HF trial (2020-2023), which assessed the efficacy and safety of finerenone in patients with HFmrEF/HFpEF.
A total of 6001 participants (mean age, 72 years; 54.5% men) across 37 countries were included, all of whom had received diuretic treatment for ≥ 30 days before randomisation, had left ventricular ejection fraction ≥ 40%, and had elevated natriuretic peptide levels. Participants received either finerenone (titrated to 20 mg or 40 mg) or placebo.
The PREDICT-HFpEF risk calculator used 16 independent predictors to evaluate 1- and 2-year outcomes, with model performance assessed using the Harrell C statistic.
The PREDICT-HFpEF risk scores for the composite outcome of cardiovascular death or HF hospitalisation, cardiovascular death alone, and all-cause death were calculated and compared with observed outcomes.
Patients were divided into quintiles according to their PREDICT-HFpEF score for cardiovascular death or HF hospitalisation.

The PREDICT-HFpEF model performed well in predicting the composite of cardiovascular death or HF hospitalisation (C statistic, 0.71; 95% CI, 0.69-0.72), cardiovascular death alone (C statistic, 0.68; 95% CI, 0.66-0.71), and all-cause death (C statistic, 0.69; 95% CI, 0.67-0.71) at 2 years.
The composite outcome occurred more frequently in the highest vs lowest risk quintile, with event rates of 23.1 (95% CI, 21.1-25.4) vs 2.6 (95% CI, 2.1-3.2) per 100 patient-years, aligning well with predicted risk.
Relative risk reduction with finerenone remained consistent across risk quintiles for all outcomes.
Absolute risk reduction with finerenone was greatest in high-risk patients, with the number needed to treat ranging from 200 in the lowest risk quintile to 21 in the highest risk quintile per 100 person-years of treatment.

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