The UK’s NICE has issued draft guidance recommending finerenone as an option for treating adults with heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF), marking a potential expansion of the non-steroidal mineralocorticoid receptor antagonist’s use within the NHS for patients with chronic symptomatic heart failure.
Draft recommendation issued
Published on 15 July 2026, the draft technology appraisal supports the use of finerenone within its marketing authorisation for eligible patients with HFpEF or HFmrEF. The recommendation follows NICE’s assessment of the therapy’s clinical and cost effectiveness and remains subject to consultation before final guidance is published. According to NICE, “up to 280,000 people could be eligible for finerenone” if the recommendation is confirmed.
“Of the estimated 635,000 people in England who have heart failure, half have preserved or mildly reduced ejection fraction.”
Potential to broaden heart failure treatment
Heart failure with preserved or mildly reduced ejection fraction accounts for approximately half of all heart failure cases and has historically had fewer evidence-based treatment options than heart failure with reduced ejection fraction. In its assessment, NICE concluded that finerenone improved cardiovascular outcomes compared with placebo when added to standard care, supporting its use as a new treatment option for eligible patients. The draft recommendation therefore represents an important milestone in expanding pharmacological treatment choices for this patient population.
Next steps for NICE
Finerenone was first recommended by NICE in March 2023 for selected adults with stage 3 or 4 chronic kidney disease associated with Type 2 diabetes. If the current draft recommendation is confirmed following consultation, it would represent the therapy’s first NICE recommendation for heart failure with preserved or mildly reduced ejection fraction, broadening access for eligible patients across England and Wales.
NICE is expected to publish its final technology appraisal guidance later in July 2026, following consideration of stakeholder feedback received during the consultation process.
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