Finerenone and Reduced Sudden Death Across CKM Stages A prespecified FINE-HEART analysis of 18,991 adults published in JACC

Authors

  • Dr Ashutosh Mishra English Author

Keywords:

Finerenone, Sudden death, CKM stages, FINE‑HEART analysis, Arrhythmic mortality, Risk stratification

Abstract

Abstract 
Background: Sudden death is a major and often underappreciated component of cardiovascular mortality among patients with overlapping cardiovascular, kidney, and metabolic (CKM) disease. A prespecified FINE‑HEART analysis evaluated the association between finerenone and sudden death across CKM stages in 18,991 adults.

Methods and population: Participant‑level data were pooled and analyzed over a median follow‑up of 2.9 years. Sudden death events and potential predictors were assessed across CKM Stages 2–4. Finerenone dosing mirrored trial protocols, initiated at 10–20 mg once daily and titrated according to eGFR.

Results: Sudden death occurred in 418 participants (2.2%) and comprised 47% of cardiovascular deaths. Finerenone reduced sudden‑death risk by 19% compared with placebo (P = .034), with a number needed to treat of 216 to prevent one sudden death. Risk rose markedly with disease stage: Stage 4 patients had a 2.7‑fold higher sudden‑death risk than those in Stages 2–3 (P < .001). Independent predictors included older age, prior heart failure, atrial fibrillation, prior myocardial infarction, higher urinary albumin‑to‑creatinine ratio, lower systolic blood pressure, and reduced kidney function (all P < .05).

Conclusions and implications: The analysis demonstrates that a substantial portion of cardiovascular mortality in CKM is sudden and potentially preventable. Stage‑dependent risk stratification using routinely collected clinical variables can identify patients who may derive the greatest absolute benefit from finerenone. These findings reinforce finerenone’s role in guideline‑directed therapy for patients with combined cardiorenal risk and support prioritizing Stage 4 patients for intensive monitoring and treatment.

NEWSLETTER 10 Finerenone and Reduced Sudden Death Across CKM Stages A prespecified FINE-HEART analysis of 18,991 adults published in JACC Figure 10. Finerenone and Reduced Sudden Death Across CKM Stages — mechanism overview (illustrative; labels added for education). A prespecified analysis from the FINE-HEART programme, covering 18,991 adults, examined sudden death across the CKM spectrum and was published online June 3, 2026 in the Journal of the American College of Cardiology, with lead author Alberto Foà.1 Sudden death is a particularly feared outcome in cardiometabolic disease, and this analysis is among the first to quantify it stage by stage. The burden proved substantial. Over a median 2.9 years, sudden death occurred in 418 patients (2.2%), accounting for 47% of all cardiovascular deaths—nearly half.1 That fraction underscores how much of the cardiovascular mortality in CKM is potentially arrhythmic and abrupt. Finerenone meaningfully reduced this risk. It was associated with a 19% lower risk of sudden death versus placebo (P = .034), translating into one sudden death prevented for every 216 patients treated.1 While the number needed to treat is large, the outcome prevented is catastrophic and otherwise difficult to anticipate. Risk was strongly stage-dependent. Patients with CKM Stage 4 had a 2.7-fold higher risk of sudden death than those with Stage 2 or 3 (P < .001), reinforcing the value of staging for prognosis and for targeting intensive therapy.1 Independent predictors of sudden death included older age, heart-failure history, atrial fibrillation, prior myocardial infarction, higher UACR, lower systolic blood pressure, and reduced kidney function (all P < .05)—a profile most clinicians will recognise immediately.1 The stage-dependence of sudden death is clinically actionable. Knowing that Stage 4 patients face a 2.7-fold higher risk than those at Stage 2 or 3 helps target the most intensive monitoring and therapy to those who stand to gain most.1 The recognisable predictor profile—older age, prior heart failure or myocardial infarction, atrial fibrillation, higher UACR, lower systolic pressure, and reduced kidney function—maps neatly onto data most clinics already collect, so risk can be flagged without new tests.1 Practical dosing mirrored the trials: finerenone was given once daily, starting at 10–20 mg and titrated to 20–40 mg by eGFR, with the analysis excluding the earliest and most advanced CKM stages.1 Corroborating pooled datasets—including the INFINITY analysis and the Lancet CKD pooled analysis—support finerenone’s consistent cardiovascular and kidney benefit, positioning sudden-death reduction as one more reason to consider it across appropriate CKM patients.3,4 References 1. Finerenone May Cut Sudden Death Risk Across the CKM Spectrum, Medscape, June 16, 2026. https://www.medscape.com/viewarticle/finerenone-may-cut-risk-sudden-death-across-ckm-spectrum-2026a1000kau 2. FINE-HEART pooled analysis (cancer subanalysis), Eur J Heart Fail, June 29, 2026. https://academic.oup.com/eurjhf/article/28/Supplement_2/xuag193.1363/8721035 3. Bayer's INFINITY Analysis Shows Finerenone Delivers Long-Term Kidney and Heart Protection, Clival, June 9, 2026. https://clival.com/news/bayers-infinity-analysis-shows-finerenone-delivers-long-term-kidney-and-heart-protection-in-chronic-kidney-disease 4. Efficacy and safety of finerenone in CKD (pooled analysis), Lancet, June 13, 2026 (PMID 42248158). https://pubmed.ncbi.nlm.nih.gov/42248158/ 5. 2026 CKM Guideline — Top Things to Know, professional.heart.org, June 9, 2026. https://professional.heart.org/en/science-news/2026-guideline-for-the-prevention-detection-evaluation-and-management-of-ckm-syndrome/top-things-to-know 6. New guideline reframes weight as health risk, AHA Newsroom, June 9, 2026. https://newsroom.heart.org/news/new-guideline-reframes-weight-as-health-risk-tied-to-diabetes-kidney-and-heart-conditions

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Published

2026-07-07

Issue

Vol. 4 No. 10 (2026): Finerenone and Reduced Sudden Death Across CKM Stages A prespecified FINE-HEART analysis of 18,991 adults published in JACC

Section

Articles

How to Cite

Finerenone and Reduced Sudden Death Across CKM Stages A prespecified FINE-HEART analysis of 18,991 adults published in JACC. (2026). Diabzen, 4(10), 20-21. https://thediabzen.com/index.php/d/article/view/50

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