What changed in the 2026 ESC heart failure guideline
The guideline's own tables of new concepts, new recommendations and revised recommendations (Tables 4–6), quoted from the guideline text and slide set, with the Class and Level of evidence. The 2021 wording of revised items is paraphrased.
Prefer to watch? The two-part lecture on the 2026 ESC guideline is on the Lectures page.
New concepts
- HFrEF has been expanded to include LVEF up to 50%
- HFmrEF has been removed
- HFpEF includes LVEF from 50% and above
- Decompensated HF replaces acute HF
- Stages of HF (A–D) ranging from risk factors to advanced HF have been adopted
- New classifications for medical and interventional therapy have been introduced (FMT, AMT, GDIT)
“HFrEF has been expanded to include LVEF up to 50% HFmrEF has been removed HFpEF includes LVEF from 50% and above Decompensated HF replaces acute HF Stages of HF (A–D) ranging from risk factors to advanced HF have been adopted New classifications for medical and interventional therapy have been introduced”
New recommendations (38)
Revised recommendations (13)
Each shows what the 2021 guideline said (paraphrased) and the 2026 wording with its new Class and Level. Where the guideline text interleaves the two columns, only the part of the 2026 wording that reads contiguously is quoted.