Yasin Çağlayan/ Alamy Stock Photo
Up to 280,000 people in England could be eligible for a new drug to treat heart failure with preserved or mildly reduced ejection fraction, the National Institute for Health and Care Excellence (NICE) has said.
In final draft guidance published on 15 July 2026, NICE recommended that finerenone (Kerendia; Bayer) could be used — within its marketing authorisation — as an option to treat symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults.
The drug is a mineralocorticoid receptor antagonist (MRA), which should be considered alongside an angiotensin-converting enzyme inhibitor, a beta-blocker and a sodium-glucose cotransporter-2 (SGLT2) inhibitor for treating heart failure with mildly reduced ejection fraction, the draft guidance said.
It added that finerenone could be used as an alternative to spironolactone. While the drugs have not been directly compared in a clinical trial in this population, indirect comparison suggests that finerenone may work as well as spironolactone, the draft guidance noted.
According to the draft guidance, finerenone does not have the same side effects profile as steroidal MRAs, which for spironolactone can include gynaecomastia in men.
In addition, finerenone may have added benefit for patients who also have chronic kidney disease, which is already recommended for use in this condition for patients with type 2 diabetes mellitus, the draft guidance said.
The draft guidance added: “People with heart failure may also have related health conditions such as diabetes, kidney disease and hypertension. The treatments for other conditions may also help with their heart failure, so treatment options are tailored for each person.”
In its submission to NICE, published on 15 July 2026, finerenone manufacturer Bayer said that before starting treatment with finerenone tablets, patients must be tested for serum potassium levels and renal function. It continued that periodic monitoring of potassium levels may be necessary to determine if a dose adjustment is needed during treatment with finerenone.
Vicky Ruszala, a specialist pharmacist in cardiology and heart failure at North Bristol NHS Trust, welcomed the final draft guidance and suggested that specialist hospital teams could initiate finerenone in eligible patients who had been admitted with a decompensated episode of heart failure with preserved ejection fraction.
However, she said that the vast majority of eligible patients were not admitted to hospital and would instead be under the care of GP teams. They also may not even have a diagnosis of heart failure with preserved or mildly reduced ejection fraction and therefore would not have been identified as eligible for the treatment, Ruszala said.
She added that a lack of funding for the work might inhibit take-up of the recommendation.
“I think it’s fantastic that we have it as an option. I think the trial is good enough that we can say this does add benefit, and I really like the fact that it tackles the whole CVRM [cardiovascular, renal and metabolism] spectrum… but I think rolling out will be fraught with problems in different areas depending on how the area is set up as to who’s expected to recommend this and who’s expected to see it and start it, and is there going to be a pushback from primary care and secondary care?” Ruszala said.
She also noted that in her area, cardiovascular teams were encouraging primary care clinicians to identify eligible patients and consider finerenone at the same time as identifying patients eligible for SGLT2s under NICE heart failure guidance.
However, Ruszala recognised that capacity and confidence in doing so might be limited in primary care, while the capacity to support clinicians from secondary care was also limited.
If neighbourhood health teams were more developed, finerenone would be “exactly the kind of drug that would be well managed in that kind of setting,” she said.
On 7 July 2026, the government published a national cardiovascular disease framework, along with a strategic vision and delivery model.
The government’s three-year plan focused on the need to find “the missing millions with undiagnosed or unmanaged CVKM risk factors”, while case-finding could take place in GP surgeries, pharmacies and other neighbourhood settings.
On 12 July 2026, the Alliance for Heart Failure told The Pharmaceutical Journal that there is an “urgent need for the growing burden of heart failure to be recognised, from government down to ICB [integrated care board] leaders, as a national health emergency”, adding that clinicians “must of course be equipped with the right training, guidance and resources” to identify heart failure patients.
In a report — ‘Primary care: a call to action‘, published in 2025 — the Alliance for Heart Failure highlighted the potential to build a heart failure check into the existing hypertension case-finding service in pharmacies.
Commenting on the draft guidance, Helen Knight, director of medicines evaluation at NICE, said: “We’re committed to bring the best care to people fast, while at the same time ensuring value for money for the taxpayer.
“Today’s final draft guidance means there is a further effective treatment available on the NHS for people with this type of heart failure. 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.”
NICE said it expects to publish its final guidance on finerenone in August 2026.
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