{"id":138611,"date":"2024-11-21T13:51:06","date_gmt":"2024-11-21T18:51:06","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138611"},"modified":"2026-02-12T11:14:37","modified_gmt":"2026-02-12T16:14:37","slug":"in-a-hierarchical-composite-outcome-finerenone-shows-reduction-in-hf-exacerbations-in-hfmref-or-hfpef-finearts","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138611","title":{"rendered":"In a Hierarchical Composite Outcome, Finerenone Shows Reduction in HF Exacerbations in HFmrEF or HFpEF: FINEARTS"},"content":{"rendered":"<p><strong>KEY POINTS:<\/strong><\/p>\n<ul>\n<li>Hierarchical analysis prioritizing significant events more effectively traditional composite outcomes, offering clearer clinical guidance<\/li>\n<li>In a pre-specified analysis, using a win-ratio and win-odds approach, finerenone demonstrated a reduction in heart failure events compared to placebo<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p>Composite outcomes are frequently used in clinical trials, but a limitation is that they combine severe outcomes such as mortality, with less severe outcomes, such as hospitalization. Hierarchical analysis provides a valuable approach to interpreting trial data in a more meaningful way by prioritizing outcomes based on their clinical importance.<\/p>\n<p>At the American Heart Association Scientific Sessions 2024, Dr Toru Kondu from the University of Glasgow presented an abstract featuring a hierarchical analysis of the FINEARTS-HF trial. This analysis using win-ratio, win-odds, and net benefit over a two year period was part of a pre-specified subgroup evaluation of the trial, originally published in the <em>New England Journal of Medicine<\/em> in September 2024<\/p>\n<p>The FINEARTS-HF trial demonstrated that finerenone, a non-steroidal MRA significantly reduced the risk of hospitalization or urgent outpatient visits in patients with HFpEF and HFmrEF compared to placebo in addition to standard of care treatment.<\/p>\n<p>It was a multi-center, randomized, double-blind, placebo-controlled trial, over 6,00 participants with symptomatic heart failure with a left ventricular ejection fraction greater than or equal to 40% in which participants were assigned to finerenone or placebo in a 1:1 fashion. The primary endpoint in the main trial was a composite of heart failure exacerbations requiring hospitalization or urgent outpatient follow up and cardiovascular death.<\/p>\n<p>In the hierarchical analysis, Dr. Kondu re-ordered the outcome by prioritizing them in the following order: first cardiovascular death; second, both the total number and time to heart failure event; and third, the total number of urgent heart failure outpatient visits.<\/p>\n<p>The analysis revealed, 825 in the finerenone group, compared to 1012 events in the placebo group for a win ratio of 1.17 (95% CI 1.04-1.32; P=0.01). A win ratio greater than 1 indicates more wins than loses and with the medication. The win-odds, which considers ties (e.g. neither the participant on finerenone or on placebo suffers cardiovascular death or heart failure exacerbation), were 1.05 (95% CI, 1.01-1.09;\u00a0<em>P<\/em>\u00a0= .01). The absolute risk difference was 2.6% (95% CI, 0.6-4.5%). As observed in the main trial, the primary benefit was prevention of heart failure exacerbation, rather than reduction in cardiovascular death.<\/p>\n<p>Finerenone treatment led to a significant improvement in a composite hierarchical outcome that incorporated CV death, total HF hospitalizations, and total urgent HF visits, with early onset benefit.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>KEY POINTS: Hierarchical analysis prioritizing significant events more effectively traditional composite outcomes, offering clearer clinical guidance In a pre-specified analysis, using a win-ratio and win-odds approach, finerenone demonstrated a reduction in heart failure events compared to placebo<\/p>\n","protected":false},"author":40622,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[896,8],"tags":[897,45,47,185],"ppma_author":[1078],"class_list":{"0":"post-138611","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-aha-2024","7":"category-news","8":"tag-aha-2024","9":"tag-conference","10":"tag-featured","11":"tag-news","12":"author-john-vitarello-md"},"authors":[{"term_id":1078,"user_id":40622,"is_guest":0,"slug":"john-vitarello-md","display_name":"John Vitarello MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138611","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40622"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138611"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138611\/revisions"}],"predecessor-version":[{"id":138613,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138611\/revisions\/138613"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138611"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138611"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138611"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138611"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}