Finerenone, eplerenone, and spironolactone in heart failure with preserved ejection fraction: a Bayesian network meta-analysis of efficacy and safety.

Eur J Heart FailSep 15, 2026
Clinical ResearchCardiology

Vitor Bagattoli, Helena Schell Dos Santos, Juliana Giorgi et al.

✦ AI-curated · Sources linked

In 30 seconds

This Bayesian network meta-analysis evaluated the efficacy and safety of finerenone, eplerenone, and spironolactone in patients with heart failure with preserved or mildly reduced ejection fraction. Analyzing data from 10,644 patients, finerenone significantly reduced hospitalization for heart failure (RR 0.84; 95% CrI 0.75-0.93), while no MRA significantly impacted cardiovascular mortality.

Key findings

  • Finerenone reduced hospitalization for heart failure vs placebo (RR 0.84; 95% CrI 0.75-0.93).
  • Spironolactone and eplerenone showed non-significant effects on hospitalization for heart failure.
  • All MRAs increased the risk of hyperkalaemia compared to placebo.
  • No MRA significantly reduced cardiovascular mortality.

Why it matters

Understanding the comparative effectiveness of MRAs in heart failure with preserved ejection fraction is crucial for optimizing treatment strategies. This analysis suggests that finerenone may provide a better balance of efficacy and safety.

Source

PubMed · PMID 41831311

Published in Eur J Heart Fail. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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