Strategic Insights into Heart Failure Management: The Roles of Finerenone and Vascular Cell Adhesion Molecules

Heart failure management is evolving, driven by emerging drugs like finerenone and by emerging research on novel biomarkers such as vascular cell adhesion molecules. With ongoing developments, cardiologists are reassessing treatment strategies through the dual lens of pharmacotherapy and biomarker research.

In FINEARTS-HF, among patients with HFmrEF/HFpEF, finerenone reduced a composite of cardiovascular outcomes, and this effect appeared consistent across frailty strata.

Managing heart failure amidst frailty remains a central concern, particularly when personalized treatment strategies are considered. Frailty impacts the clinical approach, making it vital to integrate comprehensive care paradigms.

Observed benefits were consistent across frailty strata. While exploratory analyses suggest potential dose–response signals, optimal dosing for HF populations remains to be defined and should follow trial protocols and labeling.

Beyond dosing considerations, risk stratification tools—such as emerging biomarker panels—offer complementary insights into prognosis.

VCAM-1 emerges as a prognostic biomarker associated with adverse heart failure outcomes.

Disruption of immune pathways is linked with heightened inflammation and may contribute to heart failure progression, with molecules such as VCAM-1 and ICAM-1 associated with inflammatory pathways and immune cell recruitment.

Such findings are reshaping how clinicians think about risk assessment, but current guidelines continue to prioritize natriuretic peptides and troponin; adhesion molecules like VCAM-1 and ICAM-1 remain investigational for routine management.

The potential utility of these markers in clinical settings—primarily within research or specialized contexts—opens opportunities for more tailored interventions over time.

Despite these advancements, personalized care paths remain underutilized. Integrating these insights into routine practice will require further validation, demonstration of cost-effectiveness, and alignment with guideline-endorsed pathways, even as the field moves toward more tailored heart failure management.

Key Takeaways:

• In HFmrEF/HFpEF, finerenone’s benefits appear consistent across frailty strata based on composite cardiovascular outcomes.
• Adhesion molecule biomarkers like VCAM-1/ICAM-1 are investigational and currently serve a prognostic role rather than guiding routine therapy.
• Broader adoption will depend on further validation, cost-effectiveness, and alignment with guideline-backed pathways.