Effectiveness and safety of Finerenone in patients with heart failure: A retrospective study in China

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This study investigated the benefits and outcomes of finerenone in patients with HF using a single-center, real-world study design. Methods This single-center, retrospective observational study included consecutive patients diagnosed with HF and treated with add-on finerenone between August 2023 and May 2024 at Tongji Hospital, Shanghai, China. All patients received finerenone add-on to standard treatment. Subgroup analyses were performed in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF). Adverse events were recorded, including HF readmission, outpatient visits for acute HF, and diuretic dosage escalation. Laboratory and cardiac function markers were also collected. Results Seventy-three patients were included. Left atrial diameter decreased from 50 mm to 49 mm at 6 months and further decreased to 48 mm at 12 months (P < 0.001). The E/e’ ratio decreased from a median value of 10.65 to 9.20 at 6 months and to 8.20 at 12 months (P < 0.001). The median NT-proBNP decreased from 3 months of treatment (30.41%) and continued to decline, with a 67.47% decrease at 12 months (P < 0.001). New York Heart Association (NYHA) improved from baseline (Class II: 58.9%; Class III: 41.1%) to 12 months (Class I: 5.5%; Class II: 94.5%) (P < 0.001). These changes were consistent among the HFrEF, HFmrEF, and HFpEF subgroups. LVEF improved by a median of 2% at 6 months and 3% at 12 months (P < 0.001). No patients discontinued finerenone due to adverse events, suggesting that the drug was well tolerated in real-world patients with HF. Eight (11.0%) patients were re-admitted due to HF, and seven (9.6%) required an increase in diuretic dosage during follow-up. Conclusion In real-world clinical practice, finerenone exhibited a good clinical and safety profile in patients with HF, with profiles similar across the HFrEF, HFmrEF, and HFpEF subgroups. Future larger-sample, multicenter randomized controlled trials are needed to confirm those benefits. finerenone heart failure heart failure preserved ejection fraction heart failure reduced ejection fraction natriuretic peptide brain Figures Figure 1 Figure 2 Introduction Heart failure (HF) is the severe terminal stage of various cardiovascular diseases and has become a major global public health issue. The prevalence rate of heart failure among Chinese aged ≥ 35 is 1.3%, representing over 10 million patients. Furthermore, prevalence increases with population aging [ 1 ]. Despite recent significant progress in drug therapy (such as angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 (SGLT2) inhibitors, etc.) and device therapy, the prognosis of patients with HF remains poor, with a 5-year survival rate of only about 50%. The readmission and mortality rates of HF remain high, imposing a heavy burden on the healthcare system [ 2 , 3 ]. The first-generation steroidal mineralocorticoid receptor antagonist (MRA), spironolactone, and the second-generation MRA, eplerenone, significantly reduce mortality and the risk of hospitalization in patients with HF with reduced ejection fraction (HFrEF) [ 4 , 5 ], as supported by guidelines [ 6 , 7 ]. However, the efficacy of such drugs in patients with HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF) remains unclear, as revealed by the TOPCAT study despite its criticisms [ 8 ], leading to guidelines’ conservative attitude towards MRAs in patients with HFmrEF/HFpEF [ 6 , 7 ]. Finerenone is a recent nonsteroidal MRA approved for the treatment of chronic kidney disease associated with type 2 diabetes in 2021 in the United States of America (USA) and in 2022 by the European Union and China. Compared with traditional steroidal MRAs, finerenone has higher receptor selectivity and different physicochemical properties, with a more balanced distribution in the heart and kidneys [ 9 ]. Finerenone has significant cardiorenal protective effects in patients with chronic kidney disease complicated with type 2 diabetes. The FIDELIO-DKD and FIGARO-DKD trials confirmed that finerenone can reduce the urinary albumin-to-creatinine ratio, delay the progression of renal function loss, and significantly reduce new-onset HF events [ 10 , 11 ]. Prespecified subgroup analysis showed that finerenone can bring consistent clinical benefits regardless of whether patients have concurrent HF. The FINEARTS-HF study, published in 2024, showed that in patients with HF and left ventricular ejection fraction (LVEF) ≥ 40%, finerenone significantly reduced the risk of the composite endpoint of HF worsening and cardiovascular death, and significantly improved the patient-reported Kansas City Cardiomyopathy Questionnaire score [ 12 ], providing new hope for the treatment of HFmrEF/HFpEF. Therefore, finerenone was approved in 2025 for the management of HFmrEF and HFpEF in the USA, Canada, and Japan. However, finerenone’s new HF indication is currently supported almost entirely by non‑Chinese data, and the National Medical Products Administration (NMPA) of China has not yet approved this indication. A comparison between patients from China and Sweden showed that hospitalized HF patients in China were younger, received less angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and β‑blocker therapy, and differed in comorbidity profiles compared with Scandinavian/European cohorts, despite having broadly similar short‑term prognosis when age‑adjusted [ 13 ]. These phenotypic and treatment differences mean that extrapolating HF trial data (including finerenone trials, largely conducted in Europe/North America) to Chinese patients is uncertain, especially regarding background therapy, age distribution, ischemic burden, and biomarker profiles [ 14 ]. Although the results of randomized controlled trials are encouraging, data on the application of finerenone in real-world patients with HF remain limited. Real-world studies can reflect the actual efficacy and safety of drugs under conditions of complex comorbidities, polypharmacy, and varying treatment adherence, which are important complements to evidence from randomized controlled trials [ 15 , 16 ]. Given that HF often coexists with comorbidities such as chronic kidney disease and type 2 diabetes, the efficacy and safety of finerenone in real clinical practice urgently need further verification. Therefore, this study aimed to evaluate the benefits and patient outcomes of finerenone in patients with HF through a single-center real-world study. The results should provide real-world evidence for the clinical application of finerenone in HF in China. Materials and Methods Study design and population This single-center, retrospective observational study included consecutive patients diagnosed with HF and treated with add-on finerenone between August 2023 and May 2024 at the Department of Cardiology of Tongji Hospital, Shanghai, China. The study protocol was approved by the Ethics Committee of Tongji Hospital, Shanghai (approval #K-2025-094). The committee waived the requirement for individual informed consent due to the study’s retrospective nature. The inclusion criteria were 1) aged ≥ 18 years, 2) diagnosed with HF, 3) receiving a standard treatment regimen, based on which finerenone was initiated, and 4) regularly followed up for at least 12 months. The exclusion criteria were 1) concomitant use of potent CYP3A4 inhibitors (e.g., ketoconazole or clarithromycin), 2) baseline serum potassium levels > 5.0 mmol/L, 3) baseline estimated glomerular filtration rate (eGFR) < 25 mL/min/1.73 m 2 , or 4) acute HF with hemodynamic instability. Data collection and outcomes All data were extracted from the patient charts and clinical databases, including laboratory indicators (serum potassium, serum creatinine (for calculating eGFR), and NT-proBNP levels), cardiac function indicators (New York Heart Association (NYHA) functional class, LVEF, left atrial diameter (LAD), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’), and adverse events. The observational clinical outcomes were assessed at serial follow-up intervals. NT-proBNP levels and NYHA functional class were evaluated at baseline and at 1, 3, 6, 9, and 12 months. Key echocardiographic parameters—including LAD, E/e’, and left LVEF—were measured at baseline, 6 months, and 12 months. Safety outcomes included the incidence of adverse events such as an eGFR decrease > 40% from baseline, hyperkalemia (serum potassium > 5.5 mmol/L), hypokalemia, and symptomatic hypotension and clinical events included HF readmission, outpatient visits for acute HF, and diuretic dosage escalation. Subgroup analyses were performed by HF type. HFrEF was defined as the presence of typical symptoms (e.g., dyspnea and fatigue) and/or signs (e.g., pulmonary rales and lower extremity edema) of HF, with an LVEF of ≤ 40%. HFmrEF was defined as the presence of symptoms and/or signs of HF, with LVEF between 41% and 49%. A diagnosis of HFpEF had to meet all the following conditions: 1) presence of signs (e.g., jugular vein distension) and/or symptoms (e.g., exertional dyspnea) of HF, or current use of loop diuretics to prevent HF symptoms; 2) LVEF ≥ 50%; 3) objective evidence of left ventricular diastolic dysfunction/elevated filling pressure, with at least one of the following: i) elevated natriuretic peptide levels: In sinus rhythm, B-type natriuretic peptide (BNP) > 35 ng/L and/or N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 125 ng/L; for patients with atrial fibrillation, BNP ≥ 105 ng/L or NT-proBNP ≥ 365 ng/L; ii) abnormal cardiac structure or function confirmed by echocardiography, such as mean E/e’ ratio > 14 at rest or during exercise stress, or invasive hemodynamic examination showing pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg at rest or ≥ 25 mmHg under stress. Statistical analysis R 4.4.0 was used for statistical analysis. Categorical data were described as n (%). Continuous data were tested for normality using the Shapiro-Wilk test. Data conforming to a normal distribution were described as means ± standard deviations, while non-normally distributed data were described as medians (ranges). Intergroup comparisons were performed using independent-samples t-tests, analysis of variance (ANOVA), Mann-Whitney U tests, or Kruskal-Wallis tests, depending on the data characteristics. Repeated measurement data were analyzed using generalized estimating equations, and pairwise intergroup comparisons were corrected using the Bonferroni method. All tests were two-tailed, with P < 0.05 considered statistically significant. Results Characteristics of the patients Seventy-threepatients who received finerenone treatment for at least 12 months were included in this study. Patients with HFrEF were switched to finerenone due to intolerance to spironolactone (e.g., gynecomastia) and unavailability of eplerenone. There were no changes in medication in the included patients during the study period. The patient characteristics are detailed in Table 1 . The median age was 72 years old, and males accounted for the majority (65.8%). The patients had a heavy burden of comorbidities, with coronary heart disease (68.5%), hypertension (65.8%), and type 2 diabetes mellitus (52.1%) being the most common. According to HF classification, HFpEF patients were the main group, accounting for 63.0% (46/73), while HFmrEF and HFrEF patients accounted for 17.8% (13/73) and 19.2% (14/73), respectively. The overall cardiac function was mainly NYHA Class II (58.9%) and Class III (41.1%). The baseline median NT-proBNP level was 1496.85 pg/mL, indicating that the overall population was at a high risk of HF decompensation. Table 1 Characteristics of the patients Sex, n (%) n Total (n = 73) 73 Female 25 (34.2) Male 48 (65.8) Age, years, median (range) 73 72.00 (41.00, 89.00) BMI, kg/m 2 , mean ± SD 73 24.74 ± 3.64 eGFR, mL/min·1.73 m 2 , mean ± SD 73 65.39 ± 19.38 eGFR, mL/min·1.73 m 2 , n (%) 73 ≤ 30 2 (2.7) > 30, ≤ 60 25 (34.3) > 60 46 (63.0) sK+, mmol/L, mean ± SD 73 3.90 ± 0.45 NT-proBNP, pg/mL, median (range) 73 1496.85 (331.20, 15302.00) NYHA class, n (%) 73 2 43 (58.9) 3 30 (41.1) LAD, median (range) 73 50.00 (32.00, 76.00) EF, %, median (range) 73 59.00 (21.00, 71.00) E/e’, median (range) 62 10.65 (4.60, 24.80) EF, n (%) 73 HFrEF (EF < 40%) 14 (19.2) HFmrEF (EF 40%-49%) 13 (17.8) HFpEF (EF ≥ 50%) 46 (63.0) SBP, mmHg, mean ± SD 73 127.37 ± 16.47 DBP, mmHg, mean ± SD 73 73.21 ± 10.69 Cr, µmol/L, median (range) 73 92.00 (50.10, 198.10) UA, µmol/L, median (range) 73 391.00 (222.10, 769.00) BUN, mg/dL, median (range) 73 7.34 (4.08, 17.80) TC, mmol/L, median (range) 65 3.61 (1.65, 6.73) TG, mmol/L, median (range) 65 1.08 (0.41, 3.97) HDL, mmol/L, median (range) 65 1.09 (0.55, 2.14) LDL, mmol/L, mean ± SD 65 2.35 ± 0.81 MAU, mg/g, median (range) 44 79.45 (1.48, 2861.10) HbA1c, %, median (range) 71 6.80 (5.10, 11.80) CRP, mg/dL, median (range) 67 2.90 (0.20, 86.30) Comorbidities, n (%) Coronary heart disease 73 50 (68.5) Hypertension 73 48 (65.8) Type 2 diabetes 73 38 (52.1) Atrial fibrillation 73 27 (37.0) Valvular heart disease 73 7 (9.6) Dilated cardiomyopathy 73 3 (4.1) Hypertrophic cardiomyopathy 73 4 (5.5) Concomitant medications, n (%) ARNI 73 25 (34.2) ARB 73 38 (52.1) β-blocker 73 38 (52.1) sGC 73 3 (4.1) Lipid-lowering drugs 73 40 (54.8) Antiplatelet drugs 73 36 (49.3) Anticoagulants 73 27 (37.0) Diuretics 73 47 (64.4) Hypoglycemic drugs 73 44 (60.3) SGLT2 inhibitor 73 39 (53.4) GLP-1 receptor agonist 73 1 (1.4) Metformin 73 11 (15.1) DPP4 inhibitor 73 3 (4.1) Insulin and analogs 73 10 (13.7) AGI 73 5 (6.8) BMI: body mass index; SD: standard deviation; eGFR: estimated glomerular filtration rate; sK+: serum potassium; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association; LAD: left atrial diameter; EF: ejection fraction; HFrEF; heart failure with reduced ejection fraction; HFmrEF: heart failure with midly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; SBP: systolic blood pressure; DBP: diastolic blood pressure; Cr: creatinine; UA: uric acid; BUN: blood urea nitrogen; TC: total cholesterol; TG: triglycerides; HDL: high-density lipoprotein; LDL: low-density lipoprotein; MAU: microalbuminuria; HbA1c: glycated hemoglobin; CRP: C-reactive protein; ARNI: angiotensin receptor neprilysin inhibitors; ARB: angiotensin receptor blocker; sGC: soluble guanylate cyclase; SGLT2: sodium-glucose cotransporter-2 inhibitors; GLP-1: glucagon-like peptide-1; DPP4: dipeptidyl peptidase 4; AGI: alpha-glucosidase inhibitors. In terms of renal function and electrolytes, the baseline average eGFR was 65.39 ± 19.38 mL/min/1.73 m2, and 37% of patients (27/73) had chronic kidney disease (eGFR ≤ 60 mL/min/1.73 m 2 ). The baseline serum potassium was normal, with an average of 3.90 ± 0.45 mmol/L. Regarding the background treatment regimens, all patients received guideline-directed medical therapy (GDMT). The combined usage rate of renin-angiotensin system inhibitors (RASi) (including ARNI and ARB) was 86.3%. The β-blocker usage rate was 52.1%. Notably, the SGLT2 inhibitor use rate was 53.4%, and diuretics were used in 64.4% of patients. Clinical benefits Finerenone significantly improved cardiac structure and diastolic function in patients. LAD significantly decreased from 50 mm to 49 mm at 6 months, and further decreased to 48 mm at 12 months (P < 0.001) (Fig. 1 A and Table 2 ). The E/e’ ratio, a key indicator reflecting left ventricular filling pressure and diastolic function, significantly decreased from a median value of 10.65 to 9.20 at 6 months and to 8.20 at 12 months (P < 0.001) (Fig. 1 B and Table 2 ). The subgroup analyses also showed improvements in HFpEF, HFmrEF, and HFrEF patients (Table 3 ). Table 2 Overall effectiveness Follow-up 1 month 3 months 6 months 9 months 12 months P* LAD, mm Median (range) 49.00 (31.00, 75.00) 48.00 (32.00, 73.00) < 0.001 Change, median (range) -1.00 (-11.00, 5.00) -2.00 (-15.00, 2.00) E/e’ Median (range) 9.20 (4.20, 24.30) 8.20 (4.10, 13.20) < 0.001 Change, median (range) -0.85 (-1.60, 3.90) -1.15 (-2.50, -0.30) N (missing) 62 (11) 63 (10) EF, % Median (range) 59.00 (30.00, 73.00) 60.00 (30.00, 72.00) < 0.001 Change, median (range) 2.00 (-12.00, 26.00) 3.00 (-12.00, 28.00) NT-proBNP, pg/mL Median (range) 1141.50 (120.80, 9239.00) 945.00 (176.30, 6308.00) 689.00 (146.50, 7189.00) 554.30 (149.80, 6302.00) 457.60 (91.60, 6573.00) < 0.001 Change, %, median (range) -12.21 (-24.29, -4.41) -30.41 (-46.54, -19.90) -43.58 (-60.64, -28.56) -54.48 (-67.98, -38.26) -67.47 (-78.54, -48.23) N (missing) 70 (3) 71 (2) 73 (0) 66 (7) 73 (0) NYHA Class, n (%) < 0.001 1 0 0 1 (1.4) 4 (5.6) 4 (5.5) 2 45 (63.4) 59 (80.8) 68 (93.2) 68 (94.4) 69 (94.5) 3 26 (36.6) 14 (19.2) 4 (5.5) 0 0 N (missing) 71 (2) 73 (0) 73 (0) 72 (1) 73 (0) *The P-values for repeated measurement data analyzed using the Generalized Estimating Equations represent the time effect. LAD: left atrial diameter; LAD: left atrial diameter; EF: ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association. Table 3 Effectiveness after 12 months of treatment in subgroup populations Follow-up HFrEF (n = 14) HFmrEF (n = 13) HFpEF (n = 46) LAD, mm, median (range) Baseline 49.00 (34.00, 59.00) 51.00 (44.00, 59.00) 50.00 (32.00, 76.00) 12 months 47.50 (32.00, 56.00) 48.00 (42.00, 56.00) 48.50 (33.00, 73.00) Change -1.50 (-4.00, 1.00) -3.00 (-15.00, 2.00) -2.00 (-7.00, 2.00) E/e’, median (range) Baseline 11.25 (6.50, 24.80) 11.80 (6.80, 15.50) 10.00 (4.60, 19.20) 12 months 9.50 (5.10, 12.50) 8.90 (5.60, 11.80) 7.65 (4.10, 13.20) Change -2.65 (-18.70, 2.20) -1.10 (-6.30, 0.70) -2.70 (-13.40, 1.40) N (missing) 12 (2) 13 (0) 38 (8) EF, %, median (range) Baseline 34.50 (21.00, 39.00) 42.00 (40.00, 48.00) 63.00 (50.00, 71.00) 12 months 47.50 (30.00, 60.00) 48.00 (43.00, 60.00) 64.50 (52.00, 72.00) Change 10.50 (2.00, 28.00) 5.00 (2.00, 18.00) 1.00 (-12.00, 7.00) NT-proBNP, pg/mL, median (range) Baseline 1477.42 (344.25, 15302.00) 2760.00 (331.20, 15002.00) 1415.50 (346.00, 4692.00) 12 months 668.30 (137.60, 1973.00) 880.00 (165.00, 6573.00) 427.60 (91.60, 2360.00) Change, % -54.55 (-91.73, -28.86) -69.11 (-98.51, -19.36) -68.82 (-93.44, 6.32) HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; LAD: left atrial diameter; EF: ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide. The median NT-proBNP value, a biomarker of heart failure severity, decreased significantly at 3 months of treatment (30.41%) and continued to decline. At the 12-month final follow-up, the median NT-proBNP decreased to 689 pg/mL, with a reduction of 67.47% compared with baseline (P < 0.001) (Fig. 1 C and Table 2 ). The subgroup analyses showed consistent improvements in NT-proBNP levels across entire LVEF spectrum: 68.82% in HFpEF, 69.11% in HFmrEF and 54.55% in HFrEF (Table 3 ). The patients’ clinical symptoms improved significantly. All patients had symptoms at baseline (NYHA Class II: 58.9%; Class III: 41.1%). Over the course of treatment, the proportion of patients with NYHA Class III decreased, while the proportion with NYHA Class II increased. At 12 months, 100% of patients had cardiac function classified as NYHA Class I (5.5%) or II (94.5%) (Fig. 1 D and Table 2 ). LVEF improved by a median of 2% at 6 months and 3% at 12 months (P < 0.001) (Table 2 ), but the improvements were more pronounced in the HFrEF (from a median 34.5% to 47.5%, + 10.5%) and HFmrEF (from a median of 42.0% to 48.0%, + 5.0%) than in the HFpEF (from a median of 63.0% to 64.5%, + 1.0%) subgroups (Table 3 ). Adverse events No patients discontinued finerenone due to adverse events, suggesting that the drug was well tolerated in real-world patients with HF. Eight (11.0%) patients were re-admitted due to HF, and seven (9.6%) required an increase in diuretic dosage during follow-up. The patients’ blood pressure decreased steadily during treatment. As shown in Table 4 , the systolic blood pressure and diastolic blood pressure decreased significantly from baseline (127.37 ± 16.47 / 73.21 ± 10.69 mmHg) to 1 month (121.01 ± 13.50 / 68.82 ± 8.34 mmHg, P < 0.001) and remained stable at all subsequent time points (at 12 months: 120.84 ± 12.67 / 68.78 ± 7.79 mmHg). Although the blood pressure reduction was statistically significant, no events requiring drug discontinuation due to symptomatic hypotension occurred during the study period. Only 4 patients (5.5%) had baseline SBP below 100 mmHg, and this number remained 4 at 12-month follow-up, with no reports of hypotension-related symptoms. Table 4 Changes in safety measures in the total population Follow-up 1 month 3 months 6 months 9 months 12 months SBP, mmHg Mean, SD 121.01 ± 13.50 122.65 ± 15.94 122.10 ± 13.61 122.39 ± 12.49 120.84 ± 12.67 N (missing) 73 (0) 71 (2) 73 (0) 67 (6) 73 (0) DBP, mmHg, Mean, SD 68.82 ± 8.34 69.15 ± 8.74 69.14 ± 8.86 68.67 ± 9.45 68.78 ± 7.79 N (missing) 73 (0) 71 (2) 73 (0) 67 (6) 73 (0) sK + , mmol/L Median (range) 4.20 (3.48, 5.23) 4.10 (3.06, 4.90) 4.10 (3.06, 5.41) 4.15 (3.40, 4.90) 4.10 (3.31, 4.98) N (missing) 72 (1) 71 (2) 73 (0) 66 (7) 73 (0) eGFR, mL/min·1.73 m 2 Median (range) 65.30 (28.80, 111.81) 63.30 (29.70, 98.30) 67.00 (26.40, 102.00) 70.40 (26.50, 102.00) 70.10 (28.36, 109.39) N (missing) 71 (2) 71 (2) 73 (0) 67 (6) 73 (0) SBP: systolic blood pressure; DBP: diastolic blood pressure; sK+: serum potassium; eGFR: estimated glomerular filtration rate. Serum potassium level was a key focus. As shown in Table 4 , the baseline median serum potassium was 3.90 mmol/L. At 1 month, the median serum potassium increased to 4.20 mmol/L, a significant increase from baseline (P < 0.001). Thereafter, the serum potassium remained stable at a plateau of 4.10–4.15 mmol/L for the study period. Three patients (4.1%) had serum potassium levels ≥ 5.0 mmol/L, but the maximum value did not exceed the clinical warning line of 6.0 mmol/L, and no patient discontinued treatment or was hospitalized due to hyperkalemia. Regarding renal function, as shown in Fig. 2 and Table 4 , the median eGFR showed a transient, slight decrease to 63.30 mL/min·1.73 m 2 in the early stage of treatment (at 3 months), without significant differences from baseline (67.30 mL/min·1.73 m 2 ) (P > 0.999). During treatment, eGFR showed a recovery trend, and the median eGFR increased to 70.10 mL/min·1.73 m 2 at 12 months, which was significantly higher than at 3 months (P = 0.003) and did not differ significantly from baseline (P = 0.160). Discussion It is the first study to systematically evaluate the clinical benefits and safety of finerenone in patients with HF across different LVEF subtypes in a real-world setting. The results suggested that adding finerenone to patients already receiving GDMT showed additional benefits, including improvements in cardiac structure and function. Moreover, finerenone demonstrated good tolerability and safety in patients with HF across the LVEF spectrum. These findings indicate that finerenone may serve as a promising adjuvant treatment option for patients with HF in China. The reduction in NT-proBNP levels observed in this study is of great clinical significance. In this study, the median NT-proBNP level decreased significantly from baseline after 3 months of treatment (30.41% reduction) and continued to decline, reaching 67.47% at 12 months. In the FINEARTS-HF trial, compared with the placebo group, the NT-proBNP levels in patients with HFmrEF/HFpEF decreased by 12.1% at 3 months and 12.5% at 12 months [ 17 ]. This difference may reflect the higher baseline NT‑proBNP, smaller sample size, and more intensive background optimization, and should be interpreted cautiously as a cross‑study comparison rather than evidence of superiority. As a biomarker of HF severity, a decrease in NT-proBNP suggested reduced myocardial wall tension and inhibited neurohormonal activation [ 18 ]. This finding is consistent across both the overall cohort and the HFpEF/HFmrEF subgroups, as corroborated by the FINEARTS-HF study [ 12 ]. ARTS‑HF found finerenone non‑inferior to eplerenone for achieving > 30% NT‑proBNP reduction over 90 days in HFrEF, supporting the concept that finerenone produces prognostically relevant natriuretic peptide lowering across the EF spectrum [ 19 ]. The ARTS series of studies demonstrated that finerenone has an effect comparable to that of traditional MRAs on NT-proBNP, with better safety [ 19 – 21 ]. Notably, the improvement in the E/e’ ratio was mainly observed in HFpEF/HFmrEF subgroups, reflecting reduced left ventricular filling pressure, which is similar to the improvement in diastolic function by spironolactone in the Aldo-DHF study [ 22 ]. In addition, a pooled analysis of spironolactone in HFpEF (including Aldo‑DHF and TOPCAT) confirmed favorable effects on echocardiographic structure and function, particularly E/e’, further supporting the biological plausibility of the echocardiographic findings in the present study [ 23 ]. Mechanistically, the cardioprotective effect of finerenone may be related to its unique pharmacological properties. Preclinical studies have shown that finerenone can alleviate cardiac diastolic dysfunction and improve cardiac perfusion in models of HFpEF [ 24 ]. Compared with eplerenone, finerenone can more effectively improve left ventricular function in a rat HF model induced by coronary artery ligation [ 25 ]. In the present study, there was an improvement in NYHA class distribution with finerenone treatment, with all patients achieving NYHA Class I or II, and with all Class III patients at baseline having an improvement. In the FINEARTS-HF trial, 18.6% of patients had improved NYHA class, without significant differences compared with placebo [ 12 ]. This discrepancy likely reflects differences in study design (single‑arm vs. randomized), sample size, baseline NYHA distribution, and potential expectation or observer bias in an open‑label setting. In FINEARTS‑HF, finerenone improved KCCQ symptom scores and reduced worsening HF events across the LVEF spectrum, suggesting that the NYHA improvements are directionally concordant with trial‑level evidence of better symptoms and fewer HF events [ 26 , 27 ]. A retrospective study published in 2025 further confirmed that finerenone may have superior cardiovascular protective effects compared with traditional MRAs in patients with type 2 diabetes [ 28 ]. This finding provides important evidence for the clinical application of finerenone, but further verification through prospective studies is still needed. HFpEF accounts for more than half of patients with HF, and its 5-year survival rate is not significantly different from that of HFrEF [ 1 ]. Currently, there are limited treatment options for HFpEF, and the emergence of finerenone brings new hope to this field. This study showed that finerenone significantly improved NT-proBNP levels, NYHA functional class, and cardiac structural and functional parameters in HFpEF patients, findings corroborated by the Aldo-DHF study [ 22 ]. Based on the results of the FINEARTS-HF study [ 12 ] and the real-world evidence from this study, finerenone may become an important treatment option for HFpEF. For HFrEF, a clinical trial of finerenone in patients intolerant to spironolactone is ongoing (ClinicalTrials.gov NCT06033950). The present study suggests the benefits of finerenone in patients with HFrEF, lending credibility to the ongoing trial. The safety profiles of finerenone in this study are encouraging. Consistent with the results of randomized controlled trials such as FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF [ 10 , 11 , 29 ], finerenone showed good tolerability in the real world, with no patients discontinuing treatment due to adverse events. Notably, the incidence of hyperkalemia in this study was lower than in randomized controlled trials, which may be related to the high rate of SGLT2 inhibitor use (53.4%). SGLT2 inhibitors are known to have a potassium-excreting effect [ 30 , 31 ], which may partially offset the potassium-elevating effect of finerenone. In addition, the trend of a transient, slight decrease in eGFR in the early stage followed by recovery is consistent with the adaptive regulation of intraglomerular pressure induced by MRA drugs. This hemodynamic change may be related to long-term renal protective effects [ 28 ]. In the FIDELIO-DKD and FIGARO-DKD studies, finerenone exhibited clear renal protective effects [ 10 , 11 ]. Compared with traditional steroidal MRAs, finerenone has unique pharmacological advantages. Its nonsteroidal structure endows it with greater receptor selectivity and distinct tissue distribution [ 7 ]. This difference may explain its improved safety profile, such as a lower risk of hyperkalemia and endocrine-related adverse reactions. Limitations and future directions This study has several limitations. The single-center observational design may introduce selection bias, and the sample size was limited. There was no randomization or control group, and the 12-month follow-up period may not be sufficient to assess long-term effects. Future studies with larger sample sizes and longer follow-up periods are needed to verify the long-term benefits of finerenone. Particularly worthy of exploration are synergistic effects with SGLT2 inhibitors, efficacy differences across heart failure phenotypes, optimal treatment dose and duration, and impacts on patients’ quality of life. Conclusion In real-world clinical practice, finerenone demonstrated favorable clinical benefits and good tolerability in patients with HF across the entire LVEF spectrum, and could improve cardiac function and reverse cardiac remodeling. The results of this study support the notion that finerenone may become an important treatment option for HF, especially demonstrating unique value in the treatment of HFpEF/HFmrEF and in the management of cardiorenal comorbidities. The present study provides support for the benefits of finerenone in Chinese patients with HF, providing evidence to support its rational application in real-world settings. Abbreviations ACEI Angiotensin-converting enzyme inhibitor ANOVA Analysis of variance ARB Angiotensin receptor blocker ARNI Angiotensin receptor neprilysin inhibitors BMI Body mass index BNP B-type natriuretic peptide BUN Blood urea nitrogen Cr Creatinine DBP Diastolic blood pressure DPP4 Dipeptidyl peptidase 4 eGFR Estimated glomerular filtration rate GDMT Guideline-directed medical therapy GLP-1 Glucagon-like peptide-1 HbA1c Glycated hemoglobin HDL High-density lipoprotein HF Heart failure HFmrEF Heart failure with mildly reduced ejection fraction HFpEF Heart failure with preserved ejection fraction HFrEF Heart failure with reduced ejection fraction LAD Left atrial diameter LDL Low-density lipoprotein LVEF Left ventricular ejection fraction MAU Microalbuminuria MRA Mineralocorticoid receptor antagonist NMPA National Medical Products Administration NT-proBNP N-terminal pro-B-type natriuretic peptide NYHA New York Heart Association PCWP Pulmonary capillary wedge pressure RASi Renin-angiotensin system inhibitors SBP Systolic blood pressure sGC Soluble guanylate cyclase SGLT-2i Sodium-glucose cotransporter-2 inhibitors sK+ Serum potassium TC Total cholesterol TG Triglycerides UA Uric acid Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Tongji Hospital, Shanghai (Approval #K-2025-094). Due to the retrospective nature of the study, the requirement for obtaining individual informed consent was waived by the Ethics Committee. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Authors' contributions Cuimei Zhao, Bing Sun, and Huifeng Xu contributed equally to this work. Cuimei Zhao and Xuebo Liu are corresponding authors. All authors read and approved the final manuscript. Funding This work was supported by the Excellent Subject Reserve Talents Program of Tongji Hospital (Grant No. HBRC1803) to Cuimei Zhao; and the Shanghai Municipal Health Commission (Grant No. 202440145) to Xuebo Liu. Author Contribution Cuimei Zhao, Bing Sun, and Huifeng Xu contributed equally to this work. Cuimei Zhao and Xuebo Liu are corresponding authors. All authors read and approved the final manuscript. Acknowledgement We sincerely thank Tongji Hospital, School of Medicine, Tongji University, Shanghai, China, for supporting this work. Our deep appreciation goes to the Department of Cardiology for providing the research environment and resources. We are profoundly grateful to all the patients who participated in this study. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and confidentiality regulations but are available from the corresponding author on reasonable request. References Wang H, Li Y, Chai K, Long Z, Yang Z, Du M, et al. Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study. Lancet Glob Health. 2024;12(4):e611–22. Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342–56. Salimian S, Hawkins NM, Dendukuri N, Mousavi N, Brophy J. Predicting death or readmission following heart failure hospitalisation: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. Open Heart. 2025;12(1). Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17. Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895–1032. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2023;44(37):3627–39. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383–92. Agarwal R, Kolkhof P, Bakris G, Bauersachs J, Haller H, Wada T, et al. Steroidal and nonsteroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021;42(2):152–61. Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020;383(23):2219–29. Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252–63. Solomon SD, McMurray JJV, Vaduganathan M, Claggett B, Jhund PS, Desai AS, et al. Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2024;391(16):1475–85. Feng Y, Chen X, Schaufelberger M, Zhang Q, Fu M. Patient-level comparison of heart failure patients in clinical phenotype and prognosis from China and Sweden. BMC Cardiovasc Disord. 2022;22(1):91. Di Lullo L, Lavalle C, Scatena A, Mariani MV, Ronco C, Bellasi A. Finerenone: Questions and Answers-The Four Fundamental Arguments on the New-Born Promising Nonsteroidal Mineralocorticoid Receptor Antagonist. J Clin Med. 2023;12(12). Kim HS, Lee S, Kim JH. Real-world Evidence versus Randomized Controlled Trial: Clinical Research Based on Electronic Medical Records. J Korean Med Sci. 2018;33(34):e213. Wilson BE, Booth CM. Real-world data: bridging the gap between clinical trials and practice. eClinicalMedicine. 2024;78. Cunningham JW, Claggett BL, Vaduganathan M, Desai AS, Jhund PS, Lam CSP, et al. Effects of finerenone on natriuretic peptide levels in heart failure with mildly reduced or preserved ejection fraction: The FINEARTS-HF trial. Eur J Heart Fail. 2025;27(8):1487–91. Eltayeb M, Squire I, Sze S. Biomarkers in heart failure: a focus on natriuretic peptides. Heart. 2024;110(11):809–18. Filippatos G, Anker SD, Böhm M, Gheorghiade M, Køber L, Krum H, et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016;37(27):2105–14. Kawanami D, Takashi Y, Muta Y, Oda N, Nagata D, Takahashi H et al. Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease. Front Pharmacol. 2021;Volume 12–2021. Talha KM, Anker SD, Butler J. SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence. Int J Heart Fail. 2023;5(2):82–90. Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781–91. Ferreira JP, Cleland JG, Girerd N, Bozec E, Rossignol P, Pellicori P, et al. Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. Eur J Heart Fail. 2023;25(1):108–13. Piccirillo F, Liporace P, Nusca A, Nafisio V, Corlianò A, Magarò F et al. Effects of Finerenone on Cardiovascular and Chronic Kidney Diseases: A New Weapon against Cardiorenal Morbidity and Mortality-A Comprehensive Review. J Cardiovasc Dev Dis. 2023;10(6). Haller H, Bertram A, Stahl K, Menne J. Finerenone: a New Mineralocorticoid Receptor Antagonist Without Hyperkalemia: an Opportunity in Patients with CKD? Curr Hypertens Rep. 2016;18(5):41. Vaduganathan M, Claggett BL, Lam CSP, Pitt B, Senni M, Shah SJ, et al. Finerenone in patients with heart failure with mildly reduced or preserved ejection fraction: Rationale and design of the FINEARTS-HF trial. Eur J Heart Fail. 2024;26(6):1324–33. Docherty KF, Henderson AD, Jhund PS, Claggett BL, Desai AS, Mueller K, et al. Efficacy and Safety of Finerenone Across the Ejection Fraction Spectrum in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the FINEARTS-HF Trial. Circulation. 2025;151(1):45–58. Chen YH, Fang YW, Chen MT, Liou HH, Tsai MH. Nonsteroidal mineralocorticoid receptor antagonists and cardiovascular events in type 2 diabetes: a retrospective study. Eur Heart J Cardiovasc Pharmacother. 2025;11(7):610–9. Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474–84. Pyne L, Rossignol P, Giles C, Junek M, Mark PB, Gallagher M, et al. Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2025;406(10505):811–20. Capelli I, Gasperoni L, Ruggeri M, Donati G, Baraldi O, Sorrenti G, et al. New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure. J Nephrol. 2020;33(1):37–48. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9027680","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616583637,"identity":"0311dd12-bcde-450b-8bf2-6461ad19b7e4","order_by":0,"name":"Cuimei Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDACCRjJzHzgQIKBDQ8/ewPRWtgSH3yoSJOR7DlAlBYQ4DE2nHHmsI3BDQf8OuRnNz988LPNIpqfncFMmrftPA/DDQbGDx9zcGthnHPM2LC3TSJ3ZjNDGlDLbR7G2Q3MkjO34dbCLJFgJs0I1LLhMMMxsBZmmQNszLx4tLBJpH8Da9l/mLENqOUcD5tEAn4tPBI5UFuYmZmB3j/Aw0NIi4RETrFhzzmJ3BmH2RiBgZzMI8FzsBmvX+RnpG988KOsLre///wHYFTa2dsfbz744SMeLdgAYwNp6kfBKBgFo2AUYAAATNdNaksnaWEAAAAASUVORK5CYII=","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":true,"prefix":"","firstName":"Cuimei","middleName":"","lastName":"Zhao","suffix":""},{"id":616583639,"identity":"0ab02489-4288-4f80-9cdd-ff551d37859a","order_by":1,"name":"Bing Sun","email":"","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Sun","suffix":""},{"id":616583640,"identity":"8ef24874-da5a-407f-bfe8-b60c33096987","order_by":2,"name":"Huifeng Xu","email":"","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Huifeng","middleName":"","lastName":"Xu","suffix":""},{"id":616583641,"identity":"5f3f3748-b635-4e18-9819-9197ff06e420","order_by":3,"name":"Yi’an Yao","email":"","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yi’an","middleName":"","lastName":"Yao","suffix":""},{"id":616583645,"identity":"526c90f3-6e9e-41f4-82fd-95c757807036","order_by":4,"name":"Feifei Huang","email":"","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Huang","suffix":""},{"id":616583646,"identity":"2304d8de-5e20-4b12-b710-98d36d52f78b","order_by":5,"name":"Xuebo Liu","email":"","orcid":"","institution":"Tongji Hospital, School of Medicine, Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Xuebo","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2026-03-04 08:24:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9027680/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9027680/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106399697,"identity":"1a1dbf76-4953-46b2-aae2-6abb7be555ee","added_by":"auto","created_at":"2026-04-08 08:31:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":110180,"visible":true,"origin":"","legend":"\u003cp\u003eEffects of finerenone on cardiac structure, function, biomarkers, and symptoms in patients with heart failure. (A) Change in left atrial anteroposterior diameter. (B) Change in E/e’ ratio. (C) Change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. (D) Change in New York Heart Association (NYHA) functional class distribution.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9027680/v1/951af0b0d261526ca4872c73.png"},{"id":106399698,"identity":"32c627b7-422d-4a4b-96e3-0d13205988f8","added_by":"auto","created_at":"2026-04-08 08:31:39","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104725,"visible":true,"origin":"","legend":"\u003cp\u003eLongitudinal changes inestimated glomerular filtration rate (eGFR) over the 12-month follow-up\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9027680/v1/2a16e9d49f1d91ecd58746d2.jpeg"},{"id":106404674,"identity":"15f16e7c-3059-46dc-94ae-2a1613c63437","added_by":"auto","created_at":"2026-04-08 09:16:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1161894,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9027680/v1/dc79c2c1-4f4a-43c2-a920-e3ad768ec94d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness and safety of Finerenone in patients with heart failure: A retrospective study in China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHeart failure (HF) is the severe terminal stage of various cardiovascular diseases and has become a major global public health issue. The prevalence rate of heart failure among Chinese aged\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;35 is 1.3%, representing over 10\u0026nbsp;million patients. Furthermore, prevalence increases with population aging [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite recent significant progress in drug therapy (such as angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 (SGLT2) inhibitors, etc.) and device therapy, the prognosis of patients with HF remains poor, with a 5-year survival rate of only about 50%. The readmission and mortality rates of HF remain high, imposing a heavy burden on the healthcare system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The first-generation steroidal mineralocorticoid receptor antagonist (MRA), spironolactone, and the second-generation MRA, eplerenone, significantly reduce mortality and the risk of hospitalization in patients with HF with reduced ejection fraction (HFrEF) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], as supported by guidelines [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the efficacy of such drugs in patients with HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF) remains unclear, as revealed by the TOPCAT study despite its criticisms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], leading to guidelines\u0026rsquo; conservative attitude towards MRAs in patients with HFmrEF/HFpEF [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Finerenone is a recent nonsteroidal MRA approved for the treatment of chronic kidney disease associated with type 2 diabetes in 2021 in the United States of America (USA) and in 2022 by the European Union and China. Compared with traditional steroidal MRAs, finerenone has higher receptor selectivity and different physicochemical properties, with a more balanced distribution in the heart and kidneys [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Finerenone has significant cardiorenal protective effects in patients with chronic kidney disease complicated with type 2 diabetes. The FIDELIO-DKD and FIGARO-DKD trials confirmed that finerenone can reduce the urinary albumin-to-creatinine ratio, delay the progression of renal function loss, and significantly reduce new-onset HF events [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Prespecified subgroup analysis showed that finerenone can bring consistent clinical benefits regardless of whether patients have concurrent HF.\u003c/p\u003e \u003cp\u003eThe FINEARTS-HF study, published in 2024, showed that in patients with HF and left ventricular ejection fraction (LVEF)\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;40%, finerenone significantly reduced the risk of the composite endpoint of HF worsening and cardiovascular death, and significantly improved the patient-reported Kansas City Cardiomyopathy Questionnaire score [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], providing new hope for the treatment of HFmrEF/HFpEF. Therefore, finerenone was approved in 2025 for the management of HFmrEF and HFpEF in the USA, Canada, and Japan.\u003c/p\u003e \u003cp\u003e However, finerenone\u0026rsquo;s new HF indication is currently supported almost entirely by non‑Chinese data, and the National Medical Products Administration (NMPA) of China has not yet approved this indication. A comparison between patients from China and Sweden showed that hospitalized HF patients in China were younger, received less angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and β‑blocker therapy, and differed in comorbidity profiles compared with Scandinavian/European cohorts, despite having broadly similar short‑term prognosis when age‑adjusted [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These phenotypic and treatment differences mean that extrapolating HF trial data (including finerenone trials, largely conducted in Europe/North America) to Chinese patients is uncertain, especially regarding background therapy, age distribution, ischemic burden, and biomarker profiles [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Although the results of randomized controlled trials are encouraging, data on the application of finerenone in real-world patients with HF remain limited. Real-world studies can reflect the actual efficacy and safety of drugs under conditions of complex comorbidities, polypharmacy, and varying treatment adherence, which are important complements to evidence from randomized controlled trials [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Given that HF often coexists with comorbidities such as chronic kidney disease and type 2 diabetes, the efficacy and safety of finerenone in real clinical practice urgently need further verification.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate the benefits and patient outcomes of finerenone in patients with HF through a single-center real-world study. The results should provide real-world evidence for the clinical application of finerenone in HF in China.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective observational study included consecutive patients diagnosed with HF and treated with add-on finerenone between August 2023 and May 2024 at the Department of Cardiology of Tongji Hospital, Shanghai, China. The study protocol was approved by the Ethics Committee of Tongji Hospital, Shanghai (approval #K-2025-094). The committee waived the requirement for individual informed consent due to the study\u0026rsquo;s retrospective nature.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were 1) aged\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;18 years, 2) diagnosed with HF, 3) receiving a standard treatment regimen, based on which finerenone was initiated, and 4) regularly followed up for at least 12 months. The exclusion criteria were 1) concomitant use of potent CYP3A4 inhibitors (e.g., ketoconazole or clarithromycin), 2) baseline serum potassium levels\u0026thinsp;\u0026gt;\u0026thinsp;5.0 mmol/L, 3) baseline estimated glomerular filtration rate (eGFR)\u0026thinsp;\u0026lt;\u0026thinsp;25 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e, or 4) acute HF with hemodynamic instability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and outcomes\u003c/h3\u003e\n\u003cp\u003eAll data were extracted from the patient charts and clinical databases, including laboratory indicators (serum potassium, serum creatinine (for calculating eGFR), and NT-proBNP levels), cardiac function indicators (New York Heart Association (NYHA) functional class, LVEF, left atrial diameter (LAD), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e\u0026rsquo;), and adverse events.\u003c/p\u003e \u003cp\u003eThe observational clinical outcomes were assessed at serial follow-up intervals. NT-proBNP levels and NYHA functional class were evaluated at baseline and at 1, 3, 6, 9, and 12 months. Key echocardiographic parameters\u0026mdash;including LAD, E/e\u0026rsquo;, and left LVEF\u0026mdash;were measured at baseline, 6 months, and 12 months. Safety outcomes included the incidence of adverse events such as an eGFR decrease\u0026thinsp;\u0026gt;\u0026thinsp;40% from baseline, hyperkalemia (serum potassium\u0026thinsp;\u0026gt;\u0026thinsp;5.5 mmol/L), hypokalemia, and symptomatic hypotension and clinical events included HF readmission, outpatient visits for acute HF, and diuretic dosage escalation.\u003c/p\u003e \u003cp\u003eSubgroup analyses were performed by HF type. HFrEF was defined as the presence of typical symptoms (e.g., dyspnea and fatigue) and/or signs (e.g., pulmonary rales and lower extremity edema) of HF, with an LVEF of \u0026le;\u0026thinsp;40%. HFmrEF was defined as the presence of symptoms and/or signs of HF, with LVEF between 41% and 49%. A diagnosis of HFpEF had to meet all the following conditions: 1) presence of signs (e.g., jugular vein distension) and/or symptoms (e.g., exertional dyspnea) of HF, or current use of loop diuretics to prevent HF symptoms; 2) LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50%; 3) objective evidence of left ventricular diastolic dysfunction/elevated filling pressure, with at least one of the following: i) elevated natriuretic peptide levels: In sinus rhythm, B-type natriuretic peptide (BNP)\u0026thinsp;\u0026gt;\u0026thinsp;35 ng/L and/or N-terminal pro-B-type natriuretic peptide (NT-proBNP)\u0026thinsp;\u0026gt;\u0026thinsp;125 ng/L; for patients with atrial fibrillation, BNP\u0026thinsp;\u0026ge;\u0026thinsp;105 ng/L or NT-proBNP\u0026thinsp;\u0026ge;\u0026thinsp;365 ng/L; ii) abnormal cardiac structure or function confirmed by echocardiography, such as mean E/e\u0026rsquo; ratio\u0026thinsp;\u0026gt;\u0026thinsp;14 at rest or during exercise stress, or invasive hemodynamic examination showing pulmonary capillary wedge pressure (PCWP)\u0026thinsp;\u0026ge;\u0026thinsp;15 mmHg at rest or \u0026ge;\u0026thinsp;25 mmHg under stress.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eR 4.4.0 was used for statistical analysis. Categorical data were described as n (%). Continuous data were tested for normality using the Shapiro-Wilk test. Data conforming to a normal distribution were described as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, while non-normally distributed data were described as medians (ranges). Intergroup comparisons were performed using independent-samples t-tests, analysis of variance (ANOVA), Mann-Whitney U tests, or Kruskal-Wallis tests, depending on the data characteristics. Repeated measurement data were analyzed using generalized estimating equations, and pairwise intergroup comparisons were corrected using the Bonferroni method. All tests were two-tailed, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the patients\u003c/h2\u003e \u003cp\u003eSeventy-threepatients who received finerenone treatment for at least 12 months were included in this study. Patients with HFrEF were switched to finerenone due to intolerance to spironolactone (e.g., gynecomastia) and unavailability of eplerenone. There were no changes in medication in the included patients during the study period.\u003c/p\u003e \u003cp\u003eThe patient characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age was 72 years old, and males accounted for the majority (65.8%). The patients had a heavy burden of comorbidities, with coronary heart disease (68.5%), hypertension (65.8%), and type 2 diabetes mellitus (52.1%) being the most common. According to HF classification, HFpEF patients were the main group, accounting for 63.0% (46/73), while HFmrEF and HFrEF patients accounted for 17.8% (13/73) and 19.2% (14/73), respectively. The overall cardiac function was mainly NYHA Class II (58.9%) and Class III (41.1%). The baseline median NT-proBNP level was 1496.85 pg/mL, indicating that the overall population was at a high risk of HF decompensation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (34.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.00 (41.00, 89.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.39\u0026thinsp;\u0026plusmn;\u0026thinsp;19.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30, \u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (34.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (63.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esK+, mmol/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNT-proBNP, pg/mL, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1496.85 (331.20, 15302.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (58.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (41.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.00 (32.00, 76.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF, %, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.00 (21.00, 71.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE/e\u0026rsquo;, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.65 (4.60, 24.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFrEF (EF\u0026thinsp;\u0026lt;\u0026thinsp;40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFmrEF (EF 40%-49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (17.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFpEF (EF\u0026thinsp;\u0026ge;\u0026thinsp;50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (63.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP, mmHg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127.37\u0026thinsp;\u0026plusmn;\u0026thinsp;16.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP, mmHg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCr, \u0026micro;mol/L, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.00 (50.10, 198.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUA, \u0026micro;mol/L, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e391.00 (222.10, 769.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN, mg/dL, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.34 (4.08, 17.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC, mmol/L, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.61 (1.65, 6.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG, mmol/L, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.08 (0.41, 3.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL, mmol/L, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09 (0.55, 2.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL, mmol/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAU, mg/g, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.45 (1.48, 2861.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c, %, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.80 (5.10, 11.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP, mg/dL, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.90 (0.20, 86.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (68.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType 2 diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (52.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (37.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValvular heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilated cardiomyopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertrophic cardiomyopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcomitant medications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (34.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (52.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eβ-blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (52.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esGC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipid-lowering drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (54.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiplatelet drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (49.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (37.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiuretics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (64.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoglycemic drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (60.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGLT2 inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (53.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLP-1 receptor agonist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetformin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (15.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDPP4 inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin and analogs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (13.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eBMI: body mass index; SD: standard deviation; eGFR: estimated glomerular filtration rate; sK+: serum potassium; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association; LAD: left atrial diameter; EF: ejection fraction; HFrEF; heart failure with reduced ejection fraction; HFmrEF: heart failure with midly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; SBP: systolic blood pressure; DBP: diastolic blood pressure; Cr: creatinine; UA: uric acid; BUN: blood urea nitrogen; TC: total cholesterol; TG: triglycerides; HDL: high-density lipoprotein; LDL: low-density lipoprotein; MAU: microalbuminuria; HbA1c: glycated hemoglobin; CRP: C-reactive protein; ARNI: angiotensin receptor neprilysin inhibitors; ARB: angiotensin receptor blocker; sGC: soluble guanylate cyclase; SGLT2: sodium-glucose cotransporter-2 inhibitors; GLP-1: glucagon-like peptide-1; DPP4: dipeptidyl peptidase 4; AGI: alpha-glucosidase inhibitors.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn terms of renal function and electrolytes, the baseline average eGFR was 65.39\u0026thinsp;\u0026plusmn;\u0026thinsp;19.38 mL/min/1.73 m2, and 37% of patients (27/73) had chronic kidney disease (eGFR\u0026thinsp;\u0026le;\u0026thinsp;60 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e). The baseline serum potassium was normal, with an average of 3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 mmol/L.\u003c/p\u003e \u003cp\u003e Regarding the background treatment regimens, all patients received guideline-directed medical therapy (GDMT). The combined usage rate of renin-angiotensin system inhibitors (RASi) (including ARNI and ARB) was 86.3%. The β-blocker usage rate was 52.1%. Notably, the SGLT2 inhibitor use rate was 53.4%, and diuretics were used in 64.4% of patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical benefits\u003c/h2\u003e \u003cp\u003eFinerenone significantly improved cardiac structure and diastolic function in patients. LAD significantly decreased from 50 mm to 49 mm at 6 months, and further decreased to 48 mm at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The E/e\u0026rsquo; ratio, a key indicator reflecting left ventricular filling pressure and diastolic function, significantly decreased from a median value of 10.65 to 9.20 at 6 months and to 8.20 at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The subgroup analyses also showed improvements in HFpEF, HFmrEF, and HFrEF patients (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverall effectiveness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.00 (31.00, 75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48.00 (32.00, 73.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChange, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.00 (-11.00, 5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.00 (-15.00, 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE/e\u0026rsquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.20 (4.20, 24.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.20 (4.10, 13.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChange, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.85 (-1.60, 3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.15 (-2.50, -0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.00 (30.00, 73.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.00 (30.00, 72.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChange, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00 (-12.00, 26.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.00 (-12.00, 28.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNT-proBNP, pg/mL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1141.50 (120.80, 9239.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e945.00 (176.30, 6308.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e689.00 (146.50, 7189.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e554.30 (149.80, 6302.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e457.60 (91.60, 6573.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange, %, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-12.21 (-24.29, -4.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-30.41 (-46.54, -19.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-43.58 (-60.64, -28.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-54.48 (-67.98, -38.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-67.47 (-78.54, -48.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNYHA Class, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (80.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (93.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69 (94.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*The P-values for repeated measurement data analyzed using the Generalized Estimating Equations represent the time effect.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLAD: left atrial diameter; LAD: left atrial diameter; EF: ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffectiveness after 12 months of treatment in subgroup populations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHFrEF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHFmrEF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHFpEF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eLAD, mm, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.00 (34.00, 59.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.00 (44.00, 59.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e50.00 (32.00, 76.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.50 (32.00, 56.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.00 (42.00, 56.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e48.50 (33.00, 73.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.50 (-4.00, 1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.00 (-15.00, 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e-2.00 (-7.00, 2.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eE/e\u0026rsquo;, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.25 (6.50, 24.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.80 (6.80, 15.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10.00 (4.60, 19.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.50 (5.10, 12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.90 (5.60, 11.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7.65 (4.10, 13.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.65 (-18.70, 2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.10 (-6.30, 0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e-2.70 (-13.40, 1.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e38 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEF, %, median (range)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.50 (21.00, 39.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.00 (40.00, 48.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e63.00 (50.00, 71.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.50 (30.00, 60.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.00 (43.00, 60.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e64.50 (52.00, 72.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.50 (2.00, 28.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00 (2.00, 18.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00 (-12.00, 7.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNT-proBNP, pg/mL, median (range)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1477.42 (344.25, 15302.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2760.00 (331.20, 15002.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1415.50 (346.00, 4692.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e668.30 (137.60, 1973.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e880.00 (165.00, 6573.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e427.60 (91.60, 2360.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-54.55 (-91.73, -28.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-69.11 (-98.51, -19.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e-68.82 (-93.44, 6.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eHFrEF: heart failure with reduced ejection fraction; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; LAD: left atrial diameter; EF: ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median NT-proBNP value, a biomarker of heart failure severity, decreased significantly at 3 months of treatment (30.41%) and continued to decline. At the 12-month final follow-up, the median NT-proBNP decreased to 689 pg/mL, with a reduction of 67.47% compared with baseline (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The subgroup analyses showed consistent improvements in NT-proBNP levels across entire LVEF spectrum: 68.82% in HFpEF, 69.11% in HFmrEF and 54.55% in HFrEF (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe patients\u0026rsquo; clinical symptoms improved significantly. All patients had symptoms at baseline (NYHA Class II: 58.9%; Class III: 41.1%). Over the course of treatment, the proportion of patients with NYHA Class III decreased, while the proportion with NYHA Class II increased. At 12 months, 100% of patients had cardiac function classified as NYHA Class I (5.5%) or II (94.5%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLVEF improved by a median of 2% at 6 months and 3% at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), but the improvements were more pronounced in the HFrEF (from a median 34.5% to 47.5%, +\u0026thinsp;10.5%) and HFmrEF (from a median of 42.0% to 48.0%, +\u0026thinsp;5.0%) than in the HFpEF (from a median of 63.0% to 64.5%, +\u0026thinsp;1.0%) subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdverse events\u003c/h3\u003e\n\u003cp\u003eNo patients discontinued finerenone due to adverse events, suggesting that the drug was well tolerated in real-world patients with HF. Eight (11.0%) patients were re-admitted due to HF, and seven (9.6%) required an increase in diuretic dosage during follow-up.\u003c/p\u003e \u003cp\u003eThe patients\u0026rsquo; blood pressure decreased steadily during treatment. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the systolic blood pressure and diastolic blood pressure decreased significantly from baseline (127.37\u0026thinsp;\u0026plusmn;\u0026thinsp;16.47 / 73.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69 mmHg) to 1 month (121.01\u0026thinsp;\u0026plusmn;\u0026thinsp;13.50 / 68.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34 mmHg, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and remained stable at all subsequent time points (at 12 months: 120.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67 / 68.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.79 mmHg). Although the blood pressure reduction was statistically significant, no events requiring drug discontinuation due to symptomatic hypotension occurred during the study period. Only 4 patients (5.5%) had baseline SBP below 100 mmHg, and this number remained 4 at 12-month follow-up, with no reports of hypotension-related symptoms.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in safety measures in the total population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean, SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121.01\u0026thinsp;\u0026plusmn;\u0026thinsp;13.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.65\u0026thinsp;\u0026plusmn;\u0026thinsp;15.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122.10\u0026thinsp;\u0026plusmn;\u0026thinsp;13.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e122.39\u0026thinsp;\u0026plusmn;\u0026thinsp;12.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e120.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP, mmHg,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean, SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.15\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.14\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esK\u003csup\u003e+\u003c/sup\u003e, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.20 (3.48, 5.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.10 (3.06, 4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.10 (3.06, 5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.15 (3.40, 4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.10 (3.31, 4.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eeGFR, mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.30 (28.80, 111.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.30 (29.70, 98.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.00 (26.40, 102.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.40 (26.50, 102.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.10 (28.36, 109.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN (missing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSBP: systolic blood pressure; DBP: diastolic blood pressure; sK+: serum potassium; eGFR: estimated glomerular filtration rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSerum potassium level was a key focus. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the baseline median serum potassium was 3.90 mmol/L. At 1 month, the median serum potassium increased to 4.20 mmol/L, a significant increase from baseline (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thereafter, the serum potassium remained stable at a plateau of 4.10\u0026ndash;4.15 mmol/L for the study period. Three patients (4.1%) had serum potassium levels\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5.0 mmol/L, but the maximum value did not exceed the clinical warning line of 6.0 mmol/L, and no patient discontinued treatment or was hospitalized due to hyperkalemia.\u003c/p\u003e \u003cp\u003eRegarding renal function, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the median eGFR showed a transient, slight decrease to 63.30 mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e in the early stage of treatment (at 3 months), without significant differences from baseline (67.30 mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e) (P\u0026thinsp;\u0026gt;\u0026thinsp;0.999). During treatment, eGFR showed a recovery trend, and the median eGFR increased to 70.10 mL/min\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e at 12 months, which was significantly higher than at 3 months (P\u0026thinsp;=\u0026thinsp;0.003) and did not differ significantly from baseline (P\u0026thinsp;=\u0026thinsp;0.160).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIt is the first study to systematically evaluate the clinical benefits and safety of finerenone in patients with HF across different LVEF subtypes in a real-world setting. The results suggested that adding finerenone to patients already receiving GDMT showed additional benefits, including improvements in cardiac structure and function. Moreover, finerenone demonstrated good tolerability and safety in patients with HF across the LVEF spectrum. These findings indicate that finerenone may serve as a promising adjuvant treatment option for patients with HF in China.\u003c/p\u003e \u003cp\u003eThe reduction in NT-proBNP levels observed in this study is of great clinical significance. In this study, the median NT-proBNP level decreased significantly from baseline after 3 months of treatment (30.41% reduction) and continued to decline, reaching 67.47% at 12 months. In the FINEARTS-HF trial, compared with the placebo group, the NT-proBNP levels in patients with HFmrEF/HFpEF decreased by 12.1% at 3 months and 12.5% at 12 months [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This difference may reflect the higher baseline NT‑proBNP, smaller sample size, and more intensive background optimization, and should be interpreted cautiously as a cross‑study comparison rather than evidence of superiority. As a biomarker of HF severity, a decrease in NT-proBNP suggested reduced myocardial wall tension and inhibited neurohormonal activation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This finding is consistent across both the overall cohort and the HFpEF/HFmrEF subgroups, as corroborated by the FINEARTS-HF study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. ARTS‑HF found finerenone non‑inferior to eplerenone for achieving\u0026thinsp;\u0026gt;\u0026thinsp;30% NT‑proBNP reduction over 90 days in HFrEF, supporting the concept that finerenone produces prognostically relevant natriuretic peptide lowering across the EF spectrum [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The ARTS series of studies demonstrated that finerenone has an effect comparable to that of traditional MRAs on NT-proBNP, with better safety [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNotably, the improvement in the E/e\u0026rsquo; ratio was mainly observed in HFpEF/HFmrEF subgroups, reflecting reduced left ventricular filling pressure, which is similar to the improvement in diastolic function by spironolactone in the Aldo-DHF study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, a pooled analysis of spironolactone in HFpEF (including Aldo‑DHF and TOPCAT) confirmed favorable effects on echocardiographic structure and function, particularly E/e\u0026rsquo;, further supporting the biological plausibility of the echocardiographic findings in the present study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Mechanistically, the cardioprotective effect of finerenone may be related to its unique pharmacological properties. Preclinical studies have shown that finerenone can alleviate cardiac diastolic dysfunction and improve cardiac perfusion in models of HFpEF [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Compared with eplerenone, finerenone can more effectively improve left ventricular function in a rat HF model induced by coronary artery ligation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, there was an improvement in NYHA class distribution with finerenone treatment, with all patients achieving NYHA Class I or II, and with all Class III patients at baseline having an improvement. In the FINEARTS-HF trial, 18.6% of patients had improved NYHA class, without significant differences compared with placebo [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This discrepancy likely reflects differences in study design (single‑arm vs. randomized), sample size, baseline NYHA distribution, and potential expectation or observer bias in an open‑label setting. In FINEARTS‑HF, finerenone improved KCCQ symptom scores and reduced worsening HF events across the LVEF spectrum, suggesting that the NYHA improvements are directionally concordant with trial‑level evidence of better symptoms and fewer HF events [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A retrospective study published in 2025 further confirmed that finerenone may have superior cardiovascular protective effects compared with traditional MRAs in patients with type 2 diabetes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This finding provides important evidence for the clinical application of finerenone, but further verification through prospective studies is still needed.\u003c/p\u003e \u003cp\u003eHFpEF accounts for more than half of patients with HF, and its 5-year survival rate is not significantly different from that of HFrEF [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Currently, there are limited treatment options for HFpEF, and the emergence of finerenone brings new hope to this field. This study showed that finerenone significantly improved NT-proBNP levels, NYHA functional class, and cardiac structural and functional parameters in HFpEF patients, findings corroborated by the Aldo-DHF study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Based on the results of the FINEARTS-HF study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and the real-world evidence from this study, finerenone may become an important treatment option for HFpEF. For HFrEF, a clinical trial of finerenone in patients intolerant to spironolactone is ongoing (ClinicalTrials.gov NCT06033950). The present study suggests the benefits of finerenone in patients with HFrEF, lending credibility to the ongoing trial.\u003c/p\u003e \u003cp\u003eThe safety profiles of finerenone in this study are encouraging. Consistent with the results of randomized controlled trials such as FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], finerenone showed good tolerability in the real world, with no patients discontinuing treatment due to adverse events. Notably, the incidence of hyperkalemia in this study was lower than in randomized controlled trials, which may be related to the high rate of SGLT2 inhibitor use (53.4%). SGLT2 inhibitors are known to have a potassium-excreting effect [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which may partially offset the potassium-elevating effect of finerenone. In addition, the trend of a transient, slight decrease in eGFR in the early stage followed by recovery is consistent with the adaptive regulation of intraglomerular pressure induced by MRA drugs. This hemodynamic change may be related to long-term renal protective effects [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the FIDELIO-DKD and FIGARO-DKD studies, finerenone exhibited clear renal protective effects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Compared with traditional steroidal MRAs, finerenone has unique pharmacological advantages. Its nonsteroidal structure endows it with greater receptor selectivity and distinct tissue distribution [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This difference may explain its improved safety profile, such as a lower risk of hyperkalemia and endocrine-related adverse reactions.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future directions\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The single-center observational design may introduce selection bias, and the sample size was limited. There was no randomization or control group, and the 12-month follow-up period may not be sufficient to assess long-term effects. Future studies with larger sample sizes and longer follow-up periods are needed to verify the long-term benefits of finerenone. Particularly worthy of exploration are synergistic effects with SGLT2 inhibitors, efficacy differences across heart failure phenotypes, optimal treatment dose and duration, and impacts on patients\u0026rsquo; quality of life.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn real-world clinical practice, finerenone demonstrated favorable clinical benefits and good tolerability in patients with HF across the entire LVEF spectrum, and could improve cardiac function and reverse cardiac remodeling. The results of this study support the notion that finerenone may become an important treatment option for HF, especially demonstrating unique value in the treatment of HFpEF/HFmrEF and in the management of cardiorenal comorbidities. The present study provides support for the benefits of finerenone in Chinese patients with HF, providing evidence to support its rational application in real-world settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eACEI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngiotensin-converting enzyme inhibitor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eANOVA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eARB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngiotensin receptor blocker\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eARNI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngiotensin receptor neprilysin inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBNP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eB-type natriuretic peptide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBUN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood urea nitrogen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCr\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiastolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDPP4\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDipeptidyl peptidase 4\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eeGFR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEstimated glomerular filtration rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGDMT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGuideline-directed medical therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGLP-1\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlucagon-like peptide-1\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHbA1c\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlycated hemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHDL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHFmrEF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart failure with mildly reduced ejection fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHFpEF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart failure with preserved ejection fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHFrEF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart failure with reduced ejection fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLAD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft atrial diameter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLDL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLVEF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft ventricular ejection fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMAU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMicroalbuminuria\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMRA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMineralocorticoid receptor antagonist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNMPA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Medical Products Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNT-proBNP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eN-terminal pro-B-type natriuretic peptide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNYHA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew York Heart Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePCWP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulmonary capillary wedge pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRASi\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRenin-angiotensin system inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003esGC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSoluble guanylate cyclase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSGLT-2i\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSodium-glucose cotransporter-2 inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003esK+\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSerum potassium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal cholesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTriglycerides\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUric acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Tongji Hospital, Shanghai (Approval #K-2025-094). Due to the retrospective nature of the study, the requirement for obtaining individual informed consent was waived by the Ethics Committee.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthors' contributions\u003c/h2\u003e \u003cp\u003eCuimei Zhao, Bing Sun, and Huifeng Xu contributed equally to this work. Cuimei Zhao and Xuebo Liu are corresponding authors. All authors read and approved the final manuscript.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Excellent Subject Reserve Talents Program of Tongji Hospital (Grant No. HBRC1803) to Cuimei Zhao; and the Shanghai Municipal Health Commission (Grant No. 202440145) to Xuebo Liu.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCuimei Zhao, Bing Sun, and Huifeng Xu contributed equally to this work. Cuimei Zhao and Xuebo Liu are corresponding authors. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely thank Tongji Hospital, School of Medicine, Tongji University, Shanghai, China, for supporting this work. Our deep appreciation goes to the Department of Cardiology for providing the research environment and resources. We are profoundly grateful to all the patients who participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and confidentiality regulations but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang H, Li Y, Chai K, Long Z, Yang Z, Du M, et al. Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study. Lancet Glob Health. 2024;12(4):e611\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalimian S, Hawkins NM, Dendukuri N, Mousavi N, Brophy J. Predicting death or readmission following heart failure hospitalisation: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. Open Heart. 2025;12(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. 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J Clin Med. 2023;12(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HS, Lee S, Kim JH. Real-world Evidence versus Randomized Controlled Trial: Clinical Research Based on Electronic Medical Records. J Korean Med Sci. 2018;33(34):e213.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson BE, Booth CM. Real-world data: bridging the gap between clinical trials and practice. eClinicalMedicine. 2024;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCunningham JW, Claggett BL, Vaduganathan M, Desai AS, Jhund PS, Lam CSP, et al. Effects of finerenone on natriuretic peptide levels in heart failure with mildly reduced or preserved ejection fraction: The FINEARTS-HF trial. Eur J Heart Fail. 2025;27(8):1487\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEltayeb M, Squire I, Sze S. Biomarkers in heart failure: a focus on natriuretic peptides. Heart. 2024;110(11):809\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFilippatos G, Anker SD, B\u0026ouml;hm M, Gheorghiade M, K\u0026oslash;ber L, Krum H, et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016;37(27):2105\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawanami D, Takashi Y, Muta Y, Oda N, Nagata D, Takahashi H et al. Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease. Front Pharmacol. 2021;Volume 12\u0026ndash;2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalha KM, Anker SD, Butler J. SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence. Int J Heart Fail. 2023;5(2):82\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira JP, Cleland JG, Girerd N, Bozec E, Rossignol P, Pellicori P, et al. Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. Eur J Heart Fail. 2023;25(1):108\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiccirillo F, Liporace P, Nusca A, Nafisio V, Corlian\u0026ograve; A, Magar\u0026ograve; F et al. Effects of Finerenone on Cardiovascular and Chronic Kidney Diseases: A New Weapon against Cardiorenal Morbidity and Mortality-A Comprehensive Review. J Cardiovasc Dev Dis. 2023;10(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaller H, Bertram A, Stahl K, Menne J. Finerenone: a New Mineralocorticoid Receptor Antagonist Without Hyperkalemia: an Opportunity in Patients with CKD? Curr Hypertens Rep. 2016;18(5):41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaduganathan M, Claggett BL, Lam CSP, Pitt B, Senni M, Shah SJ, et al. Finerenone in patients with heart failure with mildly reduced or preserved ejection fraction: Rationale and design of the FINEARTS-HF trial. Eur J Heart Fail. 2024;26(6):1324\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDocherty KF, Henderson AD, Jhund PS, Claggett BL, Desai AS, Mueller K, et al. Efficacy and Safety of Finerenone Across the Ejection Fraction Spectrum in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the FINEARTS-HF Trial. Circulation. 2025;151(1):45\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YH, Fang YW, Chen MT, Liou HH, Tsai MH. Nonsteroidal mineralocorticoid receptor antagonists and cardiovascular events in type 2 diabetes: a retrospective study. Eur Heart J Cardiovasc Pharmacother. 2025;11(7):610\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePyne L, Rossignol P, Giles C, Junek M, Mark PB, Gallagher M, et al. Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2025;406(10505):811\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapelli I, Gasperoni L, Ruggeri M, Donati G, Baraldi O, Sorrenti G, et al. New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure. J Nephrol. 2020;33(1):37\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"finerenone, heart failure, heart failure, preserved ejection fraction, heart failure, reduced ejection fraction, natriuretic peptide, brain","lastPublishedDoi":"10.21203/rs.3.rs-9027680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9027680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eFinerenone is a highly selective nonsteroidal mineralocorticoid receptor antagonist, but data on its benefits in the treatment of heart failure (HF) in real-world clinical practice remain insufficient. This study investigated the benefits and outcomes of finerenone in patients with HF using a single-center, real-world study design.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective observational study included consecutive patients diagnosed with HF and treated with add-on finerenone between August 2023 and May 2024 at Tongji Hospital, Shanghai, China. All patients received finerenone add-on to standard treatment. Subgroup analyses were performed in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF). Adverse events were recorded, including HF readmission, outpatient visits for acute HF, and diuretic dosage escalation. Laboratory and cardiac function markers were also collected.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeventy-three patients were included. Left atrial diameter decreased from 50 mm to 49 mm at 6 months and further decreased to 48 mm at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The E/e\u0026rsquo; ratio decreased from a median value of 10.65 to 9.20 at 6 months and to 8.20 at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The median NT-proBNP decreased from 3 months of treatment (30.41%) and continued to decline, with a 67.47% decrease at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). New York Heart Association (NYHA) improved from baseline (Class II: 58.9%; Class III: 41.1%) to 12 months (Class I: 5.5%; Class II: 94.5%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These changes were consistent among the HFrEF, HFmrEF, and HFpEF subgroups. LVEF improved by a median of 2% at 6 months and 3% at 12 months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No patients discontinued finerenone due to adverse events, suggesting that the drug was well tolerated in real-world patients with HF. Eight (11.0%) patients were re-admitted due to HF, and seven (9.6%) required an increase in diuretic dosage during follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn real-world clinical practice, finerenone exhibited a good clinical and safety profile in patients with HF, with profiles similar across the HFrEF, HFmrEF, and HFpEF subgroups. Future larger-sample, multicenter randomized controlled trials are needed to confirm those benefits.\u003c/p\u003e","manuscriptTitle":"Effectiveness and safety of Finerenone in patients with heart failure: A retrospective study in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 08:31:30","doi":"10.21203/rs.3.rs-9027680/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-02T10:29:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T04:57:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-11T04:16:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T17:06:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-03-09T13:33:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d1d3858-c088-4fe3-82c9-34fbe0e0a937","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T08:31:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 08:31:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9027680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9027680","identity":"rs-9027680","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}