The European Society for Cardiology (ESC) has announced an update to their guidelines for the management of chronic heart failure (CHF) highlighting the crucial role of mineralocorticoid receptor antagonists (MRA) in the management of patients with heart failure. The new guidelines state that the combination of “an ACE inhibitor [or angiotensin receptor blocker (ARB)], a beta-blocker, and an MRA, are fundamentally important in modifying the course of systolic HF and should at least be considered in every patient”. This update provides welcome guidance to UK clinicians as it builds upon existing NICE guidance developed before the EMPHASISHF trial results were published. Results of the EMPHASIS-HF trial showed that eplerenone reduces the risk of cardiovascular death or heart failure hospitalisation by more than a third compared to placebo in HF patients already receiving current standard therapy. These results were achieved against a quality of background therapy seldom seen in day to day clinical practice—94% of patients in the eplerenone arm were also receiving an ACE inhibitor and over 86% were receiving a beta-blocker.