Highlights from

ACC 2021

American College of Cardiology Annual Congress 2021

Virtual 15-17 May 2021

Finerenone may reduce risk of AF onset in patients with CKD and diabetes

Summary: An analysis of the FIDELIO-DKD trial showed that finerenone may decrease new-onset atrial fibrillation or flutter (AFF) in patients who have type 2 diabetes (T2D) and chronic kidney disease (CKD).1,2

T2D and CKD are both promoters of AFF via structural and/or electrical remodelling, which is triggered by activation of mineralocorticoid receptors. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist with anti-inflammatory and anti-fibrotic effects. Prof Gerasimos Filippatos (Attikon University Hospital, Greece) presented a prespecified analysis of the FIDELIO-DKD trial (NCT02540993).1 The analysis examined the cardiorenal effects and impact of finerenone on new-onset AFF in participants with T2D and CKD. The multicentre, double-blinded, phase III FIDELIO-DKD trial randomised 5,674 participants to receive either finerenone or a placebo. Of the 5,674 participants, 461 (8.1%) had AFF at baseline, while 5,213 (91.9%) did not. Of the 5,213 participants with no pre-existing AFF, 2,593 (49.7%) received finerenone, and 2,620 (50.3%) participants received a placebo. The primary endpoint was a composite of kidney failure, a sustained decrease of ≥40% in renal function, or renal death. The key secondary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure. Both endpoints were analysed by AFF history. New-onset AFF occurred in 82 (3.2%) patients in the finerenone arm, and 117 (4.5%) patients in the placebo arm, yielding an incidence rate/100 patient-years of 1.20 and 1.72, respectively, with a hazard ratio of 0.71 (95% CI 0.53-0.94; P=0.0164) and an absolute risk reduction of 1.3%. Prof Filippatos noted that the following baseline characteristics seemed to have no effect on finerenone’s protective effect:

  • age
  • sex
  • kidney characteristics
  • baseline serum potassium levels
  • systolic blood pressure
  • body mass index
  • glycated haemoglobin (HbA1c)
  • use of glucose-lowering therapies

One of the limitations identified with this study is the fact that electrocardiograms were performed only once per year, raising the possibility that asymptomatic AFF may have been missed.2

  1. Fillipatos G. Finerenone and new onset of atrial fibrillation or flutter in patients with chronic kidney disease and type 2 diabetes. Abstract 411-16, ACC 2021 Scientific Session, 15-17 May 2021
  2. Fillipatos G et al. Finerenone Reduces onset of atrial fibrillation in patients with chronic kidney disease and type 2 diabetes. Am Coll Cardiol 2021 online 17 May 2021 [abstract]
  3. Naccarelli GV, Filippone E J, Foy A. Do mineralcorticoid receptor antagonists suppress atrial fibrillation/flutter? J Am Coll Cardiol 2021, May 17 [full text]

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Article image: agrobacter

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.