UPDATED heart failure guidelines from the European Society of Cardiology (ESC) have introduced new classifications for disease stages, phenotypes, and therapies.
The new guidelines presented during the ESC Congress 2026 are said to reflect advances in understanding and treatment while placing greater emphasis on prevention and earlier intervention, according to the guideline’s authors.
Overall, the updated recommendations aim to support evidence-based care across the full spectrum of patients with heart failure.
The revised guidance adopts a staging approach that covers the continuum from individuals at risk of heart failure through to patients with advanced disease.
Heart failure is described as a clinical syndrome caused by impaired cardiac function, remaining a significant health burden.
The guidelines estimated prevalence of heart failure 1 to 3% among the general adult population, stating that despite improvements in outcomes over recent decades, fewer than 60% of patients diagnosed with heart failure were alive 5 years after diagnosis.
The guidance highlights concerns that the burden of heart failure could continue to increase because of population ageing, rising obesity rates, and the growing prevalence of cardiovascular risk factors.
As a result, prevention and timely treatment initiation were emphasised throughout the recommendations.
A major update within the heart failure guidelines involved simplification of disease phenotypes.
Previous recommendations defined three phenotypes according to left ventricular ejection fraction (LVEF). The updated framework reduced this to two categories.
Heart failure with reduced ejection fraction is now defined as an LVEF below 50%, while heart failure with preserved ejection fraction is defined as 50% or greater.
The previous category of heart failure with mildly reduced ejection fraction was removed due to evidence suggesting these patients shared similar pathophysiology and treatment responses with those classified as having reduced ejection fraction.
Another terminology change replaced the term “acute” heart failure with “decompensated” heart failure. The revision is said to reflect recognition that worsening cardiac function may occur gradually rather than through sudden deterioration.
The guidelines also introduced new therapy classifications. Treatments were grouped into foundational medical therapy, additional medical therapy, and guideline-directed interventional therapy. This structure was developed with the intention of remaining relevant as future drugs and devices become available.
Several recommendations were updated following new evidence. These included Class 1 recommendations for mineralocorticoid receptor antagonists in chronic heart failure regardless of LVEF.
Class 2a recommendations were also issued for semaglutide and tirzepatide in patients with preserved LVEF and obesity.
The document additionally included guidance on patient education and self-care, highlighting the importance of informed decision-making and patient involvement in long-term heart failure management.
2026 ESC Guidelines for the management of heart failure. Eur Heart J. 2026;DOI:10.1093/eurheartj/ehag100.
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