EFFECT OF FINERENONE ON FUNCTIONAL CAPACITY AND CLINICAL STABILITY IN PATIENTS WITH HFPEF AND HFMREF

Abstract

Heart failure with preserved (HFpEF) and mildly reduced (HFmrEF) ejection fraction remains a major clinical challenge because of its high prevalence, persistent functional limitation, and substantial morbidity and mortality. Finerenone has demonstrated cardiovascular and renal benefits, although its early effects on functional capacity and quality of life remain insufficiently explored. To evaluate the impact of switching from spironolactone to finerenone on functional capacity, quality of life, and renal safety in patients with HFpEF and HFmrEF, complemented by the description of a very elderly patient. Narrative review with a comparative analysis of the scientific evidence involving patients with heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) who underwent replacement of spironolactone with finerenone. Functional capacity was assessed using the six-minute walk test (6MWT), health status using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and renal function and serum potassium were evaluated at baseline and after 30 days. As a complementary analysis, the 12-month clinical course of a 99-year-old patient treated with finerenone and dapagliflozin was described. The FINE-FUNCTION HF study included 53 patients (71.8 ± 1.3 years; LVEF 57.8 ± 1.3%). The distance covered during the 6-minute walk test (6MWT) increased from 263.6 to 302.0 meters (Δ 38.4 m; 95% CI: 15.9–41.4; p < 0.001), and the total Kansas City Cardiomyopathy Questionnaire (KCCQ) score improved from 48.5 to 67.1 points (p < 0.001). No clinically relevant changes were observed in renal function or serum potassium levels. The nonagenarian patient remained clinically stable throughout the 12-month follow-up, with no rehospitalizations. Switching from spironolactone to finerenone was associated with early improvements in functional capacity and quality of life while maintaining a favorable renal and electrolyte safety profile. These findings require confirmation in multicenter studies.