NICE has released a draft update advocating earlier use of major heart failure medications—including SGLT2 inhibitors and ARNIs—managed in primary care, with the goal of saving lives and reducing hospital admissions.

Introduction

NICE’s draft guideline recommends adjusting the timing of heart failure treatments in adults with heart failure with reduced ejection fraction (HFrEF). New evidence supports starting key medications earlier in the treatment pathway.

Earlier Use of Medications

Under the revised draft:

• Four cornerstone drugs—angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BB), mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors—should be introduced without waiting to maximise the dose of any single medication.
• SGLT2 inhibitors, specifically empagliflozin and dapagliflozin, may now be prescribed at any point, including early in treatment, rather than only after full dose optimisation of other medications.
• Angiotensin receptor neprilysin inhibitors (ARNIs) should be offered to individuals who cannot tolerate ACEIs, without the previous requirement for a stable ACEI or ARB dose.

Prescribing in Primary Care

The draft guideline also proposes that GPs—supported by heart failure specialists—are able to initiate both SGLT2 inhibitors and ARNIs. This change is expected to streamline access and make it easier for patients to start treatment.

The Role of Agentis One Virtual Hub

Agentis One Virtual Hub supports private GP practices in delivering high-quality chronic disease management, including for cardiovascular conditions like heart failure. Through structured long-term condition reviews, prescription management, and ongoing patient monitoring, the Virtual Hub enables early intervention and continuity of care. By helping clinicians optimise medication plans and reduce admin, the service ensures that patients receive timely, tailored support—aligned with NICE’s call for earlier treatment access in primary care.

Expected Impact

NICE estimates that these changes could prevent around 3,000 deaths and 5,500 hospital admissions per year in England linked to chronic heart failure. The draft guideline is open to public consultation and feedback until the summer.

Citation:

National Institute for Health and Care Excellence. (2025, June 10). Updated guideline to increase access to treatments for early-stage chronic heart failure could reduce deaths and hospital admissions by thousands. NICE.