Efficacy and Safety With Early Treatment of Finerenone in Hospitalized Patients With Heart Failure (FACILITATE-HF)

FACILITATE-HF is a multicenter, randomized, double-blind, placebo-controlled trial designed to determine whether initiation of finerenone during the early phase of hospitalization has beneficial effects in patients with AHF who have left ventricular ejection fraction 40% or more.

Study Overview

• Status: Recruiting
• Conditions: Acute Heart Failure
• Intervention / Treatment: Drug: Finerenone Oral Tablet; Drug: Finerenone Placebo

• Study Type: Interventional
• Enrollment (Estimated): 550
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Yuya Matsue, MD; Phone Number: 81-3-3813-3111; Email: yuya8950@gmail.com

Study Locations

• Japan
  • Osaka, Japan
    • Recruiting
    • Osaka General Medical Center
    • Contact: Mitsutoshi Asai
  • Tokyo, Japan
    • Recruiting
    • Juntendo University Hospital
    • Contact: Yuya Matsue
  • Aichi-ken
    • Handa, Aichi-ken, Japan
      • Recruiting
      • Chita Peninsula General Medical Center
      • Contact: Susumu Suzuki
    • Nagoya, Aichi-ken, Japan
      • Recruiting
      • Nagoya University Hospital
      • Contact: Toru Kondo
    • Nagoya, Aichi-ken, Japan
      • Not yet recruiting
      • Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital
      • Contact: Hideo Oishi
    • Toyota, Aichi-ken, Japan
      • Recruiting
      • Toyota Kosei Hospital
      • Contact: Tomoaki Haga
    • Ōbu, Aichi-ken, Japan
      • Not yet recruiting
      • National Center for Geriatrics and Gerontology
      • Contact: Atsuya Shimizu
  • Ehime
    • Tōon, Ehime, Japan
      • Recruiting
      • Ehime University Hospital
      • Contact: Osamu Yamaguchi
  • Fukuoka
    • Fukuoka, Fukuoka, Japan
      • Not yet recruiting
      • Japanese Red Cross Fukuoka Hospital
      • Contact: Yasuhiro Oga
    • Iizuka, Fukuoka, Japan
      • Recruiting
      • Iizuka Hospital
      • Contact: Ryuichi Matsukawa
  • Gunma
    • Maebashi, Gunma, Japan
      • Recruiting
      • Gunma University Hospital
      • Contact: Masaru Obokata
    • Maebashi, Gunma, Japan
      • Not yet recruiting
      • Gunma Prefectural Cardiovascular Center
      • Contact: Norimichi Koitabashi
    • Takasaki, Gunma, Japan
      • Recruiting
      • NHO Takasaki General Medical Center
      • Contact: Nobuaki Fukuda
  • Hokkaido
    • Sapporo, Hokkaido, Japan
      • Recruiting
      • Hokkaido Cardiovascular Hospital
      • Contact: Kazunori Omote
  • Kanagawa
    • Sagamihara, Kanagawa, Japan
      • Not yet recruiting
      • Kitasato University Hospital
      • Contact: Takeru Nabeta
  • Osaka
    • Sakai, Osaka, Japan
      • Recruiting
      • Kindai University Hospital
      • Contact: Koichiro Matsumura
    • Suita, Osaka, Japan
      • Recruiting
      • The University of Osaka Hospital
      • Contact: Yohei Sotomi
    • Suita, Osaka, Japan
      • Not yet recruiting
      • National Cerebral and Cardiovascular Center
      • Contact: Takeshi Kitai
  • Saitama
    • Kawagoe, Saitama, Japan
      • Not yet recruiting
      • Saitama Medical Center
      • Contact: Kentaro Jujo
  • Shizuoka
    • Izunokuni, Shizuoka, Japan
      • Not yet recruiting
      • Juntendo University Shizuoka Hospital
      • Contact: Manabu Ogita
    • Kakegawa, Shizuoka, Japan
      • Recruiting
      • Chutoen General Medical Center
      • Contact: Shuji Morikawa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Patients eligible for inclusion in this study meet all of the following criteria:
Inclusion Criteria:

1. Patients ≥18 years of age, male or female
   
2. Current hospitalization with AHF requiring intravenous loop diuretics or vasodilators during the index admission
   
3. Patients have to have at least one of new or worsening symptoms due to HF and one of new or worsening physical examination findings due to HF
   (i) symptom
   dyspnoea, decreased exercise tolerance, or fatigue
   (ii) physical examination
   peripheral edema, increasing abdominal distention or ascites, pulmonary rales/crackles/crepitations, increased jugular venous pressure and/or hepatojugular reflux, S3 gallop, clinically significant or rapid weight gain
   

4. Patients who are not hemodynamically unstable as defined by meeting the following criteria
   

   1. Systolic blood pressure ≥100 mmHg and no symptoms of hypotension within 6 hours prior to randomization
      
   2. No increase in intravenous diuretic dose or intravenous vasodilators within 6 hours prior to randomization with worsening HF symptom
      
   3. Without cardiogenic shock, no use of inotropes or vasopressors, no use of mechanical circulatory support, not requiring intubation after admission, and not expected to require inotropes, vasopressors, mechanical circulatory support or intubation during the index hospitalization
      
5. NTproBNP ≥1500 pg/mL or BNP ≥375 pg/mL (For patients treated with ARNI in the previous 4 weeks prior to randomization, only NT-proBNP values should be used)
   
6. Most recent LVEF ≥40% within the past 1 year
   
7. Randomization within 24 hours after admission, and drug administration within 36 hours after admission
   
8. Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol
   
9. Signed informed consent must be obtained prior to participation in the study
   

Exclusion Criteria:

1. Estimated glomerular filtration rate (eGFR) <25 mL/min/1.73m2 by CKD-EPI Creatinine Equation (2021) at screening
   
2. Serum/plasma potassium >5.0 mmol/L at screening
   
3. Patients who cannot receive oral treatment
   
4. Use of eplerenone, spironolactone, esaxerenone or potassium-sparing diuretic within 30 days before randomization
   
5. Known hypersensitivity to the study intervention (active substance or excipients)
   
6. Systemic therapy with potent cytochrome P450 isoenzyme 3A4 (CYP3A4) inhibitors or inducers within 7 days before randomization or is expected to be used during the study period (e.g. itraconazole, ritonavir, indinavir, cobicistat, clarithromycin).
   
7. Participants who require treatment with more than one ACEI, ARB or angiotensin-receptor neprilysin inhibitor (ARNI) simultaneously
   
8. Acute heart failure in which other diseases are the main cause of symptoms and signs (chronic obstructive pulmonary disease, anemia, etc.)
   
9. Patients who are on dialysis including peritoneal dialysis or in whom the initiation of dialysis during the study period
   
10. Pregnant or lactating female
    
11. Acute coronary syndrome, pulmonary thromboembolism, stroke, or transient ischemic attack within 90 days before randomization.
    
12. Have undergone the following therapeutic intervention within 30 days before randomization: cardiovascular surgery (e.g., coronary artery bypass grafting, surgery for valvular heart disease, transcatheter aortic valve implantation, percutaneous coronary intervention, percutaneous edge-to-edge mitral valve repair, and other types of surgery at the investigator's discretion) and implantation of an implantable defibrillator, or a cardiac resynchronization therapy defibrillator.
    
13. Heart transplant recipients or patients listed for heart transplantation who are expected to undergo transplantation during the study, patients implanted with an implantable ventricular-assist device, patients expected to require an implantable ventricular-assist device during the study, and patients expected to switch to palliative care during the study.
    
14. Coronary or valvular heart disease likely to require surgical or percutaneous intervention within the study period (there is no reason to exclude secondary mitral or tricuspid regurgitation due to reduced cardiac function, except for the absence of a plan to perform cardiac surgery or therapeutic catheterization)
    
15. Secondary cardiomyopathy such as amyloidosis, cardiac sarcoidosis, hemochromatosis, Fabry's disease, chemotherapy induced cardiomyopathy, and muscular dystrophy. Heart failure due to takotsubo cardiomyopathy, obstructive hypertrophic cardiomyopathy, complex congenital heart disease (as determined by the investigator), pericardial constriction, right heart failure in absence of left-sided structural disease
    
16. Acute cardiac structural abnormalities (e.g., acute mitral regurgitation due to ruptured chordae tendineae and infective endocarditis)
    
17. Peripartum cardiomyopathy diagnosed within 6 months before randomization.
    
18. Active myocarditis at randomization.
    
19. Patients with symptomatic bradycardia or complete atrioventricular block who are being treated with temporary pacemaker implantation at the time of admission, or who are expected to require temporary or permanent pacemaker implantation in the future. Patients who have already been treated with permanent pacemaker implantation do not meet the exclusion criteria
    
20. Presence of uncontrolled thyroid disease
    
21. Addison's disease
    
22. Hepatic insufficiency classified as Child-Pugh C
    
23. Patients with excessive alcohol intake (15+ drinks/week for men, 8+ drinks/week for women)
    
24. Any other condition or therapy, which would make the participant unsuitable for this study and will not allow participation for the full planned study period (e.g. active malignancy or other condition limiting life expectancy to less than 12 months)
    
25. Patients with dementia. If a sub-investigator determines that confirmation of cognitive impairment is necessary, it must be verified that the Mini-Cog score is not less than 4.
    
26. Participation in another interventional clinical study (e.g. phase 1 to 3 clinical studies) or treatment with another investigational medicinal product within 30 days prior to randomization.Other conditions likely to interfere with the patient's safety or compliance with the protocol
    
27. Patients deemed unsuitable by the principal investigator or sub investigator

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Finerenone; Patients will be randomized 1:1 to either finerenone or placebo.	Drug: Finerenone Oral Tablet; For participants with an eGFR ≤60 mL/min/1.73 m^2: Starting dose is 10 mg OD and maximum dose 20 mg OD. For participants with an eGFR >60 mL/min/1.73 m^2: Starting dose is 20 mg OD and maximum dose 40 mg OD.
Placebo Comparator: Placebo; Placebo tablets matching finerenone are administered orally	Drug: Finerenone Placebo; Placebo tablets matching finerenone are administered orally

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
A hierarchical composite endpoint of death and worsening heart failure	A hierarchical composite endpoint consisting of death, worsening HF during hospitalization, HF rehospitalization, worsening HF after discharge requiring IV diuretic or sustained intensification of oral therapy, and change in N-terminal pro-B-type natriuretic peptide levels at 12 weeks as assessed using a win ratio	Up to 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause death		Up to 12 weeks
Cardiovascular death		Up to 12 weeks
Worsening HF during hospitalization		During hospitalization
HF rehospitalization		Up to 12 weeks
Worsening HF after discharge requiring IV diuretic or sustained intensification of oral therapy		Up to 12 weeks
NT-proBNP change from baseline to 12 weeks		Up to 12 weeks
Urine output from randomization to 48 hours		Up to 48 hours
Symptomatic atrial fibrillation up to discharge and up to 12 weeks		Up to 12 weeks
Kansas City Cardiomyopathy Questionnaire - Total Symptom Score from baseline to 12 weeks	Kansas City Cardiomyopathy Questionnaire - Total Symptom Score from baseline to 12 weeks. The scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations.	Up to 12 weeks
Change in patient dyspnea in the supine position assessed by a visual analogue scale from randomization to discharge and to 12 weeks	Change in patient dyspnea in the supine position assessed by a visual analogue scale from randomization to discharge and to 12 weeks. The scores range from 0 to 100, with 100 being the best possible score.	Up to 12 weeks

Collaborators and Investigators

• Sponsor: Juntendo University
• Investigators: Principal Investigator: Yuya Matsue, MD, Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: February 2, 2026
• First Submitted That Met QC Criteria: February 2, 2026
• First Posted (Actual): February 9, 2026

Study Record Updates

• Last Update Posted (Actual): February 11, 2026
• Last Update Submitted That Met QC Criteria: February 8, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: finerenone
• Other Study ID Numbers: jRCTs031250369

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No