Abstract
26-A-19412-ACC CLINICAL OUTCOMES AMONG HFREF PATIENTS ON SPIRONOLACTONE VS. FINERENONE: A REAL-WORLD PROPENSITY-MATCHED ANALYSIS
Journal of the American College of Cardiology, Vol.87(13 Supplement), pp.A744-A745
04/2026
DOI: 10.1016/j.jacc.2026.02.1930
Abstract
Background
Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity and mortality despite advances in therapy. Mineralocorticoid receptor antagonists (MRAs) are part of guideline-directed medical therapy, central to the management of HFrEF. Spironolactone, a non-selective steroidal MRA, has long been the standard with proven benefits but notable side effects. Finerenone, a novel non-steroidal MRA, offers greater receptor selectivity and balanced cardiac-renal activity.
Methods
This retrospective cohort study utilized the TriNetX Research Network to compare year outcomes in patients with HFrEF treated with spironolactone (n = 508,661) or finerenone (n = 963) over a 5-year period. The index event was the first documentation of systolic heart failure with MRA initiation. Primary outcomes were all-cause mortality and myocardial infarction; secondary outcomes included stroke, hospitalization, heart failure exacerbation, and cardiogenic shock.
Results
After propensity score matching, 960 patients in each cohort were well-balanced for demographics, comorbidities, and cardiovascular medications. Over a mean follow-up of approximately 1 year, finerenone demonstrated significantly superior outcomes compared to spironolactone across multiple endpoints: all-cause mortality (10.5% vs. 15.5%, p = 0.001, HR: 1.488 (CI: 1.154 - 1.919), acute myocardial infarction (14.3% vs. 19.1%, p = 0.005, HR: 1.392 (CI: 1.115 - 1.737), rehospitalization (32.2% vs. 37.4%, p = 0.017, HR: 1.231 (CI: 1.057 - 1.433), acute heart failure exacerbation (24.8% vs. 40.0%, p < 0.001, HR: 1.892 (CI: 1.609, 2.225), and cardiogenic shock (3.1% vs. 6.0%, p = 0.002, HR: 1.986 (CI: 1.276 - 3.089). Stroke rates showed a non-significant trend favoring finerenone (2.7% vs. 4.1%, p = 0.127).
Conclusion
In this matched analysis of HFrEF patients, finerenone showed better outcomes than spironolactone, but the findings should be interpreted cautiously due to the observational nature of the study.
Details
- Title: Subtitle
- 26-A-19412-ACC CLINICAL OUTCOMES AMONG HFREF PATIENTS ON SPIRONOLACTONE VS. FINERENONE: A REAL-WORLD PROPENSITY-MATCHED ANALYSIS
- Creators
- God-dowell O. Odukudu - University of IowaDivine Dele - University of IowaAdemola Ajibade - University of IowaInnocent Lutaya - University of IowaFrancois Barrett - University of IowaChinelo Madekwe - University of IowaHenry Ariri - University of IowaAbdulkareem Murtala - University of IowaEphesians Nkwetta Anutebeh - University of IowaOgheneakpobor Ubogun - University of IowaOmowunmi Fakorede - University of IowaVictory Odukudu - University of IowaChinwe E. Mbisike - University of IowaJoshua Qerbash - University of IowaGodfrey Tabowei - University of IowaSamed Obeng - University of IowaZachary Morrow - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the American College of Cardiology, Vol.87(13 Supplement), pp.A744-A745
- DOI
- 10.1016/j.jacc.2026.02.1930
- ISSN
- 0735-1097
- Publisher
- Elsevier
- Language
- English
- Date published
- 04/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985147061902771
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