Heart Failure Rewritten: What the 2026 ESC Guidelines Mean for Primary Care

Updates:

The classification of heart failure has been simplified to HFrEF <50% and HFpEF ≥50%; HFmrEF has been excluded.
Left ventricular ejection fraction of 45% = heart failure with reduced ejection fraction; this is not a “mild” form of the disease; fecal microbiota transplantation is required.
FMT = Class I, prognosis improvement fund; HFrEF: RAAS inhibitors + beta‑blocker + SGLT2 inhibitors + mineralocorticoid receptor antagonists.
AMT adds phenotype‑specific methods for treating symptoms/improving quality of life; GDIT covers devices/treatment methods.
Diagnosis update: age‑adjusted NT‑proBNP threshold values + standard UACR test; decompensated heart failure replaces acute heart failure.

Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI The analysis of the randomized study “Pragmatic Comparison of Symptomatic and Routine Stress Testing in High‑Risk Patients Who Underwent PCI” showed that the routine strategy of follow‑up functional testing 1 year after percutaneous coronary intervention does not reduce the risk of death, myocardial infarction, or hospitalization due to unstable angina within 2 years. At the same time, it more often leads to invasive coronary angiography and repeat revascularization without clinical benefit.

Intense Septal Enhancement on Cardiac MRI Flags Cardiac Amyloidosis A retrospective study showed that intensive gadolinium contrast enhancement of the anterior interatrial septum during cardiac magnetic resonance imaging, with a high degree of specificity (98%), makes it possible to diagnose cardiac amyloidosis when compared with hypertrophic cardiomyopathy and dilated cardiomyopathy.

Weight Loss During Heart Failure Hospitalization Linked to Lower 30-Day Rehospitalization Risk Patients hospitalized for heart failure who were treated with intravenous loop diuretics and achieved a weight loss of at least 2 kg between admission and discharge had a reduced risk for HF rehospitalization within 30 days.

Allergic vasospastic angina: a systematic review Allergic vasospastic angina (also known as Kunis syndrome) is a little‑studied subtype of vasospastic angina in which spasm of the coronary arteries is triggered by an allergen. Scientists conducted a study in which they assessed the clinical characteristics, mechanisms, and treatment methods for this interesting subtype of angina.

Fitness Changes Over Time Linked to Cardiovascular Risk A large UK Biobank analysis showed that even a small annual improvement in cardiorespiratory fitness among adults was independently associated with lower risks for incident cardiovascular disease and cardiovascular mortality, whereas declining fitness was linked to a progressively higher risk in a clear dose-dependent pattern.

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