IPM Take
The most interesting thing about Bayer’s ESC 2026 programme is not one drug.
It is the disappearing boundary between cardiology and nephrology.
Finerenone will dominate much of Bayer’s presence in Munich, with analyses spanning non-diabetic chronic kidney disease, atherosclerotic cardiovascular disease, heart failure and combined cardiovascular-kidney-metabolic risk. Asundexian brings secondary stroke prevention into the same portfolio, while an investigational PET tracer targets one of cardiology’s most difficult diagnostic problems, cardiac amyloidosis.
This is where precision cardiology is heading: not toward ever narrower organ silos, but toward identifying overlapping biological risk and deciding which patient needs which intervention.
The challenge for health systems is that reimbursement, guidelines and specialist pathways remain far more compartmentalised than the science.
Executive Summary
Bayer has announced 11 oral presentations for ESC Congress 2026, taking place in Munich from 28 to 31 August. The programme covers chronic kidney disease, heart failure, cardiac amyloidosis, gene therapy and secondary stroke prevention.
A major focus will be finerenone. The Phase III FIND-CKD trial previously showed that, in more than 1,500 patients with non-diabetic CKD, finerenone slowed annual eGFR decline by 0.7 mL/min/1.73 m² compared with placebo and reduced a composite cardiovascular-kidney endpoint by 23%. The INFINITY pooled analysis of more than 14,500 patients subsequently found a 24% reduction in the main kidney outcome and a 20% reduction in heart failure hospitalisation or cardiovascular death.
ESC will add new subgroup analyses rather than repeat those headline results, including finerenone outcomes in hypertensive nephropathy and according to the presence or absence of atherosclerotic cardiovascular disease.
Bayer will also present Phase III data for iodine 124 evuzamitide, an investigational PET radiotracer for suspected cardiac amyloidosis, and an analysis from OCEANIC-STROKE examining asundexian alongside dual antiplatelet therapy during the first 90 days after randomisation.
Why it matters
- HTA bodies: Evidence packages are increasingly spanning CKD, heart failure and cardiovascular risk rather than fitting neatly into a single disease category. Assessment frameworks may need to capture benefits and costs across multiple parts of the health system.
- Payers: Finerenone, Factor XIa inhibition and advanced cardiac imaging could all expand eligible patient populations. The central question will be whether broader clinical evidence translates into sufficiently precise patient selection to make uptake affordable.
- Industry / innovation partners: Bayer’s programme shows where cardiovascular R&D is moving: overlapping cardiorenal biology, earlier diagnosis and therapies aimed at residual risk after standard treatment rather than another single-organ pipeline.
Bayer is heading to ESC Congress 2026 with 11 oral presentations.
But counting abstracts misses the more interesting story.
The portfolio stretches from chronic kidney disease and heart failure to stroke prevention, cardiac amyloidosis and investigational gene therapy.
That breadth reflects a change in cardiology itself.
For decades, cardiovascular disease, kidney disease and diabetes were managed through separate specialties, guidelines and reimbursement pathways. Increasingly, the clinical evidence is showing that the same patients, pathways and risks overlap.
Finerenone sits directly in the middle of that transition.
Finerenone is becoming a cardiorenal story, not simply a diabetes drug
The strongest existing evidence Bayer brings into ESC comes from FIND-CKD and INFINITY.
FIND-CKD tested finerenone on top of standard renin-angiotensin system blockade in more than 1,500 people with non-diabetic CKD.
The primary endpoint was the annual rate of decline in estimated glomerular filtration rate. Kidney function declined by 3.3 mL/min/1.73 m² per year with finerenone compared with 4.0 with placebo, a between-group difference of 0.7. A secondary composite including kidney failure, major eGFR decline, heart failure hospitalisation or cardiovascular death was reduced by 23%.
INFINITY then pooled FIDELIO-DKD, FIGARO-DKD and FIND-CKD, creating a dataset of more than 14,500 people with diabetic and non-diabetic CKD.
Across that population, finerenone reduced the main kidney outcome by 24% and heart failure hospitalisation or cardiovascular death by 20%.
Those headline results are not new ESC findings. They were presented at the European Renal Association congress in June.
What ESC adds is granularity.
Bayer will present an analysis of FIND-CKD in patients with hypertensive nephropathy and an INFINITY analysis comparing outcomes in people with and without established atherosclerotic cardiovascular disease. Additional presentations will examine finerenone in heart failure, blood-pressure variability and combined cardiovascular-kidney-metabolic disease.
That distinction matters.
Subgroup and pooled analyses can clarify which patients may benefit most, but they should not be treated as independent pivotal trials.
Bayer is also testing two very different ways to reduce cardiovascular risk
Finerenone is only part of the programme.
Asundexian, Bayer’s investigational oral Factor XIa inhibitor, is already under FDA Priority Review for secondary prevention following non-cardioembolic ischaemic stroke or TIA.
OCEANIC-STROKE randomised 12,327 patients and found recurrent ischaemic stroke in 6.2% of the asundexian group and 8.4% of the placebo group, a 26% relative reduction. Major bleeding occurred in 1.9% and 1.7%, respectively, with no statistically significant increase. The findings were published in the New England Journal of Medicine.
At ESC, the focus will be narrower: how outcomes interacted with dual antiplatelet therapy during the first 90 days after randomisation.
The second programme targets diagnosis rather than treatment.
Bayer’s iodine 124 evuzamitide is an investigational PET radiotracer for cardiac amyloidosis. The Phase III REVEAL study has already met its primary sensitivity and specificity endpoints, and Bayer plans to present the full Phase III analysis as late-breaking science at ESC.
Cardiac amyloidosis has become increasingly treatable, but diagnosis can still take years. A new imaging tool only becomes valuable if it closes that diagnostic gap without creating another expensive layer of testing.
The bigger story is the end of single-disease cardiology
ESC 2026 will feature 59 pivotal trials across 12 Hot Line sessions, so Bayer’s programme is only a small part of a much larger congress.
But it captures a wider change in cardiovascular medicine.
The patient with CKD is also at risk of heart failure.
The patient recovering from stroke may need both antiplatelet therapy and another strategy against residual thrombotic risk.
The patient with unexplained heart failure may actually have cardiac amyloidosis and require an entirely different diagnostic and therapeutic pathway.
The science increasingly connects these conditions.
Health systems often do not.
Cardiology, nephrology, diabetology and stroke care still have different specialists, budgets, guidelines and referral pathways. New therapies that work across those boundaries raise difficult questions about who initiates treatment, who monitors patients and which budget pays.
That may ultimately be the most important message from Bayer’s ESC programme.
The pharmaceutical pipeline is already moving toward integrated cardiovascular-kidney-metabolic medicine.
Care systems now have to catch up.
