Description 
FINE‑HEART is a participant‑level pooled analysis of 18,991 adults drawn from three phase‑3 trials (FIDELIO‑DKD, FIGARO‑DKD, FINEARTS‑HF) that evaluates the effects of finerenone across the cardiovascular‑kidney‑metabolic (CKM) spectrum. Over a median 2.9 years, finerenone reduced all‑cause mortality, all‑cause and heart‑failure hospitalizations, the composite kidney outcome, and incidence of new‑onset atrial fibrillation, with consistent efficacy and safety in the 7.3% of participants who had a prior history of cancer. The analysis stratifies results by CKM stages, clarifying how benefits vary with disease severity and increasing confidence that a nonsteroidal mineralocorticoid receptor antagonist confers multiorgan protection. FINE‑HEART’s pooled design provides statistical power to detect less frequent events and supports guideline recommendations that position finerenone as an add‑on therapy for patients with persistent albuminuria and combined cardiorenal risk. The findings inform clinicians weighing finerenone for diverse CKM populations and administrators assessing its role in formularies and care pathways.