The National Institute for Health and Care Excellence (NICE) has issued final draft guidance recommending finerenone for adults with heart failure with preserved or mildly reduced ejection fraction, paving the way for broader access to the therapy through the NHS. The decision could benefit an estimated 280,000 people in England and marks an important step in expanding treatment options for a condition that has historically had limited therapies.
Heart failure with preserved or mildly reduced ejection fraction occurs when the left side of the heart does not fill properly with blood during the heart’s relaxation, or diastolic, phase. Although the heart’s pumping ability is less severely affected than in heart failure with reduced ejection fraction, the condition still limits the amount of blood reaching the body’s organs and tissues.
Patients commonly experience symptoms such as breathlessness, fatigue and swelling of the ankles. These symptoms can significantly reduce quality of life, restrict daily activities and frequently result in unplanned hospital admissions. Many people living with this form of heart failure also have additional chronic conditions, including chronic kidney disease, diabetes and hypertension, making treatment more challenging.
Finerenone belongs to a class of medicines known as mineralocorticoid receptor antagonists (MRAs). Unlike traditional MRAs, finerenone is a nonsteroidal therapy, allowing it to be used in a broader range of patients while offering an additional treatment option for clinicians managing complex cardiovascular disease.
According to NICE, expanding access to finerenone has the potential to improve long-term outcomes for patients by reducing the likelihood of emergency hospital admissions related to heart failure. Fewer hospitalizations could not only improve patient well-being and independence but also ease pressure on NHS resources.
Helen Knight, director of medicines evaluation at NICE, said the organization remains committed to ensuring patients receive effective treatments quickly while delivering value for taxpayers. She noted that the draft recommendation provides people with this form of heart failure access to another effective treatment through the NHS, with the potential to help patients live well for longer while reducing the burden of emergency hospital care.
Heart failure remains a major public health challenge in England. NICE estimates that approximately 635,000 people in England are living with heart failure, with around half of those diagnosed with preserved or mildly reduced ejection fraction. During 2023–2024, heart failure accounted for approximately 100,000 hospitalizations across England, making it one of the leading causes of avoidable hospital admissions.
The health technology assessment body believes that up to 280,000 patients could be eligible for treatment with finerenone if the recommendation is implemented.
NICE expects to publish its final guidance on finerenone in August 2026. If approved as anticipated, the therapy will become another important option for managing heart failure with preserved or mildly reduced ejection fraction, offering patients improved prospects for maintaining quality of life while potentially reducing strain on the healthcare system.