NICE approves first treatment for heart failure patients with reduced ejection fraction

NICE has recommended dapagliflozin for adults with symptomatic chronic heart failure with preserved or mildly reduced ejection fraction, making it the first NICE-recommended treatment for this type of heart failure.

Up to 150,000 patients will be eligible for treatment with dapagliflozin – a drug typically used to treat type 2 diabetes.

What is heart failure with preserved or reduced ejection fraction?

Preserved or reduced ejection fraction occurs when the muscle of the left ventricle struggles to pump enough blood out of the heart.

A normal ejection fraction is around 70%. If the EF is above 40%, this is considered preserved EF, while anything below 40% is considered as reduced EF.

If the EF is 35% or below, the patient is at high risk of developing a dangerous arrhythmia or even heart failure.

Symptoms of preserved or reduced EF include fatigue, weakness, breathlessness, orthopnoea, and oedema (swelling).

How does dapagliflozin work?

Dapagliflozin reduces the amount of work the heart has to do to pump blood around the body. This helps improve the symptoms of heart failure (including breathlessness, fatigue and swelling) and reduces the chances of the heart getting weaker.

Evidence from a clinical trial shows that adding dapagliflozin to standard care with diuretics reduces the combined risk of dying from cardiovascular causes or the likelihood of needing to go to hospital with heart failure.

NICE hope this new treatment will reduce the number of heart failure hospitalisations, which was a leading cause of inpatient treatment in 2019/20.

Dapagliflozin could save the NHS money and improve patients’ lives

Helen Knight, director of medicines evaluation at NICE, says the drug therefore has the potential not only to reduce pressure on the NHS, but also the ability to help heart failure patients to live longer, healthier lives.

Indeed, more than 550,000 people in England have heart failure and around 50% have preserved or mildly reduced ejection fraction. Every year, heart failure results in roughly 90,000 hospitalisations in England alone.

“Until now, there have been no treatments available to delay or slow the progression of this type of heart failure. The committee heard from patient and clinical experts who described how the lack of research and available treatments in this area led to a lack of hope and support that impacts the quality of life and mental health of people with the condition. And we know that chronic heart failure also places a significant burden on the NHS through hospitalisations,” Ms Knight 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 draft guidance means that for the first time there is an effective treatment available on the NHS for people with this type of heart failure.

“Not only does dapagliflozin 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,” she said.