Work

HFpEF-ABA Score and Finerenone in Patients With Heart Failure and Mildly Reduced or Preserved Ejection Fraction

Year: 2026

Type: article

Abstract: BACKGROUND: The HFpEF-ABA score is a simple diagnostic tool developed to estimate the probability of heart failure with preserved ejection fraction (HFpEF) using age, body mass index, and history of atrial fibrillation. OBJECTIVES: This study aims to evaluate the HFpEF-ABA score in patients with confirmed heart failure (HF) in the FINEARTS-HF trial, its prognostic implications, and the effect of finerenone treatment according to the HFpEF-ABA score. METHODS: FINEARTS-HF was a randomized, placebo-controlled trial enrolling patients with HF with a left ventricular ejection fraction ≥40%. HFpEF-ABA scores (as a probability between 0% and 100%) were calculated at baseline and categorized as <75%, 75%-90%, or >90%. The association between HFpEF-ABA score and clinical outcomes was examined as well as the effect of finerenone across the range of HFpEF-ABA scores. RESULTS: Among 5,988 patients with available HFpEF-ABA scores, 1,940 (32.4%) had a score <75% (low probability), 1,241 (20.7%) had a score 75%-90% (intermediate probability), and 2,807 (46.9%) had a score >90% (high probability). Rates of HF outcomes were higher in patients with higher HFpEF-ABA scores. Examination of HFpEF-ABA score as a continuous variable showed a strikingly nonlinear association with outcomes; the rate of events was similar up to a score of ∼75%, above which there was a steep increase in the event rate. Finerenone reduced events consistently across HFpEF-ABA scores. CONCLUSIONS: Despite a proven diagnosis of HF with mildly reduced ejection fraction/HFpEF, one-third of participants in FINEARTS-HF had an HFpEF-ABA score <75%, yet the therapeutic effect of finerenone was consistent across the range of HFpEF-ABA scores included. Higher HFpEF-ABA scores were associated with a greater risk of HF events. (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure [FINEARTS-HF]; NCT04435626).

Source: JACC Heart Failure

DOI: 10.1016/j.jchf.2026.103297