NICE recommends finerenone for chronic heart failure in final draft guidance
Hundreds of thousands of patients with chronic heart failure will be eligible for treatment with finerenone after its approval by the National Institute for Health and Care Excellence (NICE).
Under final draft guidance from NICE, finerenone can be an option for adults with symptomatic chronic heart failure with preserved or mildly reduced ejection fraction.
It is thought around 280,000 patients may be eligible for the mineralocorticoid receptor antagonist (MRA) which has been linked with fewer side effects than other drugs in the class.
The committee said its decision was made on the basis of clinical trial evidence showing a reduced risk of unplanned hospitalisation in those taking the drug compared with placebo.
NICE said existing guidance on chronic heart failure updated in 2025 recommends an MRA for heart failure with preserved ejection fraction alongside a (SGLT2) inhibitor.
The overhaul saw GPs prescribing a wider range of drugs for heart failure than in previous advice and with drugs to be initiated concurrently rather than each titrated individually.
But tolerability of steroidal MRAs such as spironolactone, particularly in older people with frailty or multiple co-morbidities means the drugs are often not started in this cohort.
NICE said that, as a non-steroidal MRA, finerenone may be used by more people.
The key clinical evidence for use of finerenone in this group came from the FINEARTS-HF trial published in the New England Journal of Medicine in 2024.
It found a reduction of 16% in a composite of total worsening heart-failure events (including first and recurrent hospitalisation for heart failure or urgent heart failure visit) and death from cardiovascular causes.
The NICE committee reviewing the evidence said this was largely driven by a significant reduction in worsening heart failure events of 18% with uncertainty about whether it cuts death from cardiovascular disease or other causes.
While there has been no head-to-head trial, indirect comparison suggests that finerenone may work as well as spironolactone, NICE said.
Helen Knight, director of medicines evaluation at NICE, said: ‘Heart failure can have a profound effect on people’s daily lives, often leading to repeated hospital admissions and a reduced quality of life.
‘Not only does finerenone have the potential to help them live well for longer, but it could also save the NHS money and free up space by reducing their risk of having to go to hospital for unplanned emergency treatment.’
Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said that, if benefits seen in clinical trials are replicated in the real-world, it would be beneficial for patients and the NHS.
He added that finerenone should be viewed as ‘an addition to an increasingly comprehensive treatment strategy rather than as a replacement for existing therapies’.
Most patients initially would be started on the drug under specialist care, he explained, with prescribing and monitoring then being shared with general practice.
The challenge for GPs will be ‘incorporating another effective but carefully monitored medicine into the management of patients with a complex long-term condition like heart failure’, he added.
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