Source: NICE 10th June 2025
Updated guideline to increase access to treatments for early-stage chronic heart failure could reduce
deaths and hospital admissions by thousands.
Around 3,000 deaths and 5,500 hospital admissions in England caused by
chronic heart failure could be prevented each year following our updated
draft guideline on medical treatment of the disease.
The draft guideline recommends medicines be given up to a year earlier – helping people live well for longer.
We’re updating the recommendations for drug treatments in our clinical guideline on the diagnosis and management of chronic heart failure first published in 2018.
Clinical practice over the timing of drug treatments for a type of heart failure called heart failure with a reduced ejection fraction (HFrEF) is changing. The four main types of treatment: angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB), a mineralocorticoid receptor antagonist (MRA) and a sodium-glucose cotransporter-2 (SGLT2) inhibitor are now being used earlier on and without the need to optimise the dose of any one medicine before introducing another.
Our updated guideline reflects this change in practice and in doing so they recommend an earlier use of the SGLT2 inhibitors empagliflozin and dapagliflozin than we’ve recommended before. It means they can be offered at any stage of the treatment pathway, instead of only when other medicines have been fully titrated, a process that can take over a year.
Similarly, when another type of treatment for HFrEF, an angiotensin receptor neprilysin inhibitor (ARNI) is used has also been updated in the draft guideline. It recommends these should be offered if a person can’t tolerate an ACEI, rather than only for people who are already taking a stable dose of ACEI or ARB.
For both SGLT2 inhibitors and ARNIs the draft guideline now says these can be started by GPs (with advice from a heart failure specialist) rather than solely by a heart failure specialist, potentially speeding up access to these important treatments.
Eric Power, deputy director in NICE’s Centre for Guidelines said: “Heart failure is common, with currently around 614,000 adults in England living with a diagnosis. Although there’s no cure, it is treatable, and the growing number of people living with heart failure is testament to the improvements in care introduced over recent years.
For this update we’ve been able to review the emerging evidence quickly to keep pace with changes in the treatment landscape and make recommendations that will widen access to effective treatments. This should have a big impact on the lives of people living with heart failure as well as freeing up space in hospitals by reducing their risk of having to go to hospital for unplanned emergency treatment.
Eric Power, deputy director in NICE’s Centre for Guidelines HFrEF happens when the left side of the heart doesn’t pump blood out to the body as well as normal. It is a chronic condition that affects survival and quality of life.
Based on the Office for National Statistics population and the NHS Quality and Outcomes framework 2023-24 around 614,000 adults in England have heart failure. Of these, around 63% (387,000) adults are estimated to have heart failure with reduced ejection fraction.
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