Finerenone Reduces New-Onset Atrial Fibrillation Across the Spectrum of Cardio-Kidney-Metabolic Syndrome
Maria Pabón, Gerasimos Filippatos, Brian Claggett, Michael Zi Miao, Akshay S. Desai, Pardeep S. Jhund, Alasdair D Henderson, Meike Brinker, Patrick Schloemer, Lucas Hofmeister, Li Li, Carolyn S.P. Lam, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faı̈ez Zannad, Peter Rossing, Luís M. Ruilope, Stefan D. Anker, Bertram Pitt, Rajiv Agarwal, John J.V. McMurray, Scott D. Solomon, Muthiah Vaduganathan
Abstract
BACKGROUND: Mineralocorticoid receptor antagonists (MRA) modulate cardiac and systemic pathways such as fibrosis and inflammation, which may contribute to the onset of atrial fibrillation (AF) or atrial flutter (AFL). OBJECTIVES: In this participant-level pooled analysis of 3 large clinical trials, the authors evaluated the effect of the nonsteroidal MRA finerenone on incident AF/AFL across the cardio-kidney-metabolic (CKM) spectrum. METHODS: In this prespecified analysis, we pooled participants from 2 trials of chronic kidney disease and type 2 diabetes (FIDELIO-DKD and FIGARO-DKD) and a trial of heart failure (HF) with mildly reduced or preserved ejection fraction (FINEARTS-HF). Patients were randomized 1:1 to finerenone or placebo. New-onset AF/AFL was prospectively adjudicated in all trials by blinded clinical event committees. The risk of new-onset AF/AFL was evaluated using Cox regression models stratified by region and trial. RESULTS: = 0.57). Participants with new-onset AF/AFL were at significantly higher subsequent risk of cardiovascular death, HF hospitalization, and adverse kidney outcomes. CONCLUSIONS: The nonsteroidal MRA finerenone reduced the risk of new-onset AF/AFL across the CKM spectrum.