A 65-year-old woman presents to the cardiology clinic for follow-up. She is known to have diabetes mellitus, hypertension, and heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction [LVEF] 55%). She is treated with empagliflozin 10 mg daily and furosemide 40 mg daily.
She has dyspnea on exertion and mild pedal edema. Her blood pressure is 140/70 mm Hg, heart rate is 72 bpm, and body mass index is 25.0.
Laboratory study results include estimated glomerular filtration rate 59 mL/min/1.73 m2, potassium level 3.7 mEq/L, and hemoglobin A1c concentration 5.8%.
The correct answer is: C. Initiate finerenone.
Finerenone has been shown to reduce cardiovascular death and heart failure (HF) hospitalization in patients with HF and LVEF >40% in the FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure). By subgroup analysis, the benefit was evident even in patients already treated with sodium-glucose cotransporter-2 inhibitors.
Beta-blockers are not indicated in the management of HF and are not proven to be beneficial in patients with HFpEF. The safety and efficacy of vericiguat has not been tested in patients with HFpEF and is not indicated in their management. This patient did not have marked congestion to warrant an increase in diuretic dose.
This patient case quiz is part of the larger Managing HF Across the Spectrum: From Recognizing Symptoms to Implementing Appropriate Treatment initiative, supported by Bayer. To visit the Managing HF Across the Spectrum page and access additional educational activities on this topic, click here.
References
- Heidenreich PA, Bozkurt B, Aguilar D, 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. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012
- Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107
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