Key insights from the 2026 heart failure guidelines

With Floran Sahiti, University Hospital of Wurzburg, Wurzburg - Germany and Marianna Adamo, University and Civil Hospital of Brescia, Brescia – Italy.

This episode discusses the key changes in the 2026 ESC Guidelines for the management of heart failure with Marianna Adamo, one of the Task Force chairpersons.

The conversation explores the rationale for removing HFmrEF as a separate phenotype and grouping all patients with an LVEF below 50% as HFrEF. It also covers the new emphasis on stages A to D and earlier treatment to prevent symptomatic heart failure.

It also examines diagnostic updates, including age-specific NT-proBNP cut-offs and the shift from "acute" to "decompensated" heart failure. Treatment topics include the new framework of foundational, additional and guideline-directed interventional therapies, the place of semaglutide and tirzepatide in obese patients with HFpEF, and the upgrade of LVAD to a Class I recommendation.

Finally, the episode goes behind the scenes of the consensus process, highlighting which recommendations were most debated within the Task Force.

Guideline paper: Kober L, Adamo M, Ruwald AC, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. Published online August 28, 2026. doi:10.1093/eurheartj/ehag100

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.