Major changes made to the ESC Guidelines on heart failure

The European Society of Cardiology (ESC) has released updated guidelines on heart failure, reflecting advancements in the understanding and treatment of the condition. Heart failure, a clinical syndrome resulting from the heart's improper functioning, is estimated to affect 1-3% of the adult population in the general public. While mortality rates have improved over the past three decades, less than 60% of heart failure patients are alive five years after diagnosis.

The 2026 guidelines, presented at ESC Congress 2026, aim to improve prevention, early treatment, and patient education. The guidelines have adopted a staging approach from stages A to D, categorizing patients based on risk factors and disease progression rather than left ventricular ejection fraction (LVEF). Previously classified into three phenotypes based on LVEF, heart failure is now categorized into two phenotypes: heart failure with reduced ejection fraction (LVEF less than 50%) and heart failure with preserved ejection fraction (LVEF of 50% or more).

The guidelines also emphasize the importance of prevention and starting treatment as early as possible, focusing on guidelines-directed medical therapy with three therapy classes: foundational medical therapy, additional medical therapy, and guideline-directed interventional therapy.