Finerenone's Role in Managing Heart Failure with Preserved Ejection Fraction

August 8, 2025
Finerenone's Role in Managing Heart Failure with Preserved Ejection Fraction

As heart failure with preserved ejection fraction (HFpEF) becomes an increasingly prevalent and complex cardiovascular condition, pharmacists are playing a pivotal role in navigating the therapeutic landscape, particularly with the emerging use of finerenone (Kerendia; Bayer HealthCare Pharmaceuticals Inc.), a nonsteroidal mineralocorticoid receptor antagonist (MRA) that could offer a new treatment option for this underserved patient population.

In a recent clinical forum hosted by Pharmacy Times, pharmacists gathered to discuss the implications of finerenone in HFpEF management. Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, vice president of professional services at Baptist Health System in Paducah, Kentucky, highlighted the economic impact of cardiovascular diseases and noted that the prevalence of HFpEF is increasing due to an aging population and a lack of effective treatments. Despite growing awareness, the management of HFpEF remains challenging due to nonspecific symptoms, limited clinical trial data, and diagnostic inconsistencies.

Jenna Ingram, PharmD, BCACP, ambulatory care clinical pharmacy manager of cardiology at Mount Sinai Health System in New York, emphasized the difficulties in correctly diagnosing HFpEF, stating that even within healthcare systems with heart failure registries, misclassification often occurs, as symptoms may lead to erroneous diagnoses.

Recent data from the FINEARTS-HF trial (NCT04435626) has reignited interest in finerenone, demonstrating its potential benefits in patients with mildly reduced ejection fraction or preserved ejection fraction. Unlike traditional steroidal MRAs, such as spironolactone, finerenone is nonsteroidal and may offer improved tolerability and adherence. The trial findings indicated a reduction in outpatient worsening heart failure events and atrial fibrillation, outcomes not observed in the TOPCAT trial (NCT00094302) of spironolactone, which faced significant limitations regarding its subgroup analysis.

Katherine Di Palo, PharmD, MBA, MS, senior director of transitional care excellence at Montefiore Medical Center in the Bronx, New York, noted the importance of the time-to-benefit data from FINEARTS-HF to determine whether finerenone is suitable for inpatient or outpatient use. However, despite the positive outlook, many pharmacists remain cautious about the drug's integration into routine practice until it receives formal approval and incorporation into clinical guidelines. The FDA's Prescription Drug User Fee Act (PDUFA) date for finerenone is set for July 2025.

Abhishek Shah, PharmD, BCCP, senior clinical pharmacy manager at Montefiore Medical Center, described the data from FINEARTS-HF as promising, expressing hope for its inclusion in guideline-directed medical therapy. Meanwhile, Tania Ahuja, PharmD, FACC, BCCP, BCPS, CACP, assistant director of clinical pharmacy services for cardiology and medicine at NYU Langone Health, noted the necessity for more real-world data, asserting that the findings represent a significant advancement for HFpEF treatment options.

Despite finerenone's potential, challenges remain regarding its cost and accessibility. Christopher Ho, PharmD, BCPS, manager of the pharmacy telehealth team at Northwell Health, pointed out that many HFpEF patients are older and often lack commercial insurance, making access to branded therapies difficult. Di Palo suggested that the compelling FINEARTS-HF data can facilitate discussions with prescribers, enhancing the case for finerenone's value in the therapeutic regimen.

Another significant barrier is the underutilization of existing MRAs. Mabel Chan, PharmD, BCACP, BCADM, ambulatory care clinical pharmacy specialist at NYC Health, attributed this underutilization to a lack of education among healthcare providers about the FINEARTS-HF trial, leading them to rely on outdated data from the TOPCAT trial.

Pharmacists are uniquely positioned to personalize HFpEF management through close monitoring and patient-centered strategies. Shanice Coriolan, PharmD, BCPS, BCACP, BC-ADM, a specialty pharmacist at NewYork-Presbyterian Hospital, stressed that treatment initiation should depend on individual patient characteristics and disease volume status—an evaluation pharmacists are well-equipped to perform. The emphasis on shared decision-making and tailored follow-ups, particularly through telehealth, was echoed by several panelists.

As they await FDA approval for finerenone, pharmacists are proactively assessing how this new agent may influence prescribing habits. Kaitlyn Pinkos, PharmD, BCCP, clinical pharmacy specialist at NewYork-Presbyterian Hospital, emphasized that MRAs will likely remain the first-line choice unless patients present with hypertension necessitating an angiotensin receptor-neprilysin inhibitor (ARNI).

Ultimately, pharmacists see their role evolving beyond just medication initiation and titration to encompass healthcare coordination. Di Palo remarked, "We can take a step back and view ourselves more as healthcare professionals and see ourselves as care coordinators," underscoring the importance of directing patients to appropriate specialists. As the treatment landscape for HFpEF evolves, pharmacists are proving to be essential navigators, bridging the gaps in diagnosis, education, and therapy while offering patients a more tailored and responsive approach to care.

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FinerenoneHFpEFheart failurepharmacistsBayer HealthCare Pharmaceuticalsmineralocorticoid receptor antagonistclinical trialFINEARTS-HFTOPCAT trialcardiovascular diseasetreatment managementpharmacy practicepatient careFDA approvalhealthcare coordinationchronic conditionscardiologyprescribing habitsmedication adherenceeconomic impacthealthcare professionalstelehealthpatient-centered caresymptom managementclinical pharmacyresearch dataevidence-based practicepharmaceutical educationtreatment adherencepatient outcomes

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