Objective:

To define the evidence boundaries after FINEARTS-HF for cardiovascular-kidney-metabolic (CKM)-burdened heart failure (HF) with left ventricular ejection fraction (LVEF) ≥40%.

Approach:

Key Findings:

• Finerenone reduced the composite of cardiovascular death and total worsening HF events in patients with symptomatic HF and LVEF ≥40%.
• The benefit was primarily due to fewer worsening HF events; cardiovascular death as an individual endpoint was not significantly reduced.
• CKM features help organize risk and multimorbidity but are not diagnostic or eligibility criteria.
• Implementation requires confirmed HF, exclusion of mimickers, baseline potassium and eGFR assessment, and early laboratory follow-up.

Interpretation:

Limitations:

• The review is not a systematic review or meta-analysis and lacks formal risk-of-bias scoring.
• Evidence statements are framed as outcome-supported, clinically plausible, or hypothesis-generating without quantitative pooling.

Conclusion:

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