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Guidance from the National Institute for Health and Care Excellence (NICE) has explicitly named pharmacists as part of the heart failure multidisciplinary team for the first time.
The updated guidance on chronic heart failure, published on 3 September 2025, could also enable primary care pharmacists to take on more management of the condition, as medicines are introduced earlier in the treatment pathway.
The guidance said: “The specialist heart failure multidisciplinary team should work in collaboration with the primary care team and should include… a healthcare professional with expertise in specialist prescribing for heart failure; for example, a specialist heart failure pharmacist.”
Lisa Anderson, chair of the British Society for Heart Failure, commented: “This recognition reflects the vital role specialist pharmacists play in optimising medication management, improving patient outcomes and supporting multidisciplinary care for those living with heart failure.”
Preeti Minhas, co-chair of the Alliance for Heart Failure, also welcomed the guidance’s recognition of the “invaluable contribution to tackling the growing burden of heart failure” made by pharmacists across the NHS.
“However, despite progress, implementing NICE guidelines for heart failure has not kept up the growing burden of the disease in recent years. Alongside this, at present, only 15% of heart failure clinics in the UK have a specialist pharmacist attached.
“We now need an urgent national plan, focused on workforce, education and local commissioning to transform heart failure care,” she added.
Pedro Bandiera, advanced specialist pharmacist at St George’s University Hospitals NHS Foundation Trust, said that “despite funding pressures across the NHS”, he hoped the naming of pharmacists in the NICE guidance could help hospital trusts build a business case for embedding heart failure specialist pharmacists within the multidisciplinary team.
NICE said the updated guidance could also increase the role of primary care pharmacists in managing the condition.
Rather than instructing a sequence in which medication should be introduced, the updated guidance lists treatment combinations for different scenarios.
This list of treatments could include combinations of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium–glucose co-transporter-2 (SGLT2) inhibitors — with a potential switch from an ACE inhibitor to an angiotensin receptor-neprilysin inhibitor (ARNI), where symptoms continue.
The updated guidance also removes the need for ARNIs to be initiated by a heart failure specialist. Instead, ARNIs can be prescribed by primary care prescribers on the advice of a heart failure specialist “to avoid unnecessary delays to treatment”, it added.
NICE said that the new guidance could increase prescribing of SGLT2s and ARNIs overall.
Arshad Patel, assistant professor in pharmacy practice at the University of Bradford and primary care network pharmacist, said the approach “mirrors the NHS ten-year plan of preventing disease progression early on”.
He also noted that introducing SGLT2s earlier in the heart failure pathway would mean “more patient interactions, prescribing earlier and more scope of joint up working with secondary care if needed”.
“It looks like there will be more work for primary care pharmacists to help manage these patients, which is an exciting prospect,” Patel said.
“I’m excited to work alongside my primary care colleagues to help our patients, improve health outcomes and hopefully reduce the burden on our secondary care colleagues.”
In the updated guidance, NICE said that this could impact consultation times, with staff potentially needing longer with each patient “to establish the correct combination and dose of each of medicine”.
“However, there should be a reduction in hospitalisation for heart failure,” it added.
In particular, the recommendation of an MRA for people with heart failure with preserved ejection fraction increases a patient’s risk of hyperkalaemia, which would require “careful monitoring” and would be a “significant change in practice”, NICE said.
“The impact will include staff time for consultation to establish the correct dose of MRA and treatment of hyperkalaemia. However, there is likely to be a reduction in hospitalisation for heart failure.”
NICE stressed that this should not stop clinicians from considering this treatment.
Results of a study published in August 2025 revealed that pharmacists’ interventions can significantly reduce the odds of hospitalisations from heart failure.
The study authors said at the time their findings “highlight the importance of integrating pharmacists into multidisciplinary teams to improve heart failure management for in and outpatients”.
