What is new and what has changed in the 2026 Global Heart Failure Implementation Guidelines and why

Abstract

This 2026 focused update of the original iCARDIO Alliance Global Implementation Guidelines on Heart Failure published in 2025 incorporates emerging evidence relevant to acute and chronic HF, including heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and cardiomyopathies. When patients with HFrEF experience substantial improvement in LVEF they are commonly diagnosed as having HF with improved EF (HFimpEF). We define HFimpEF to be present, when in a patient who previously was diagnosed with HFrEF an improvement in the LVEF of at least 10 percentage points to an LVEF ≥50% is observed. The main updates in the therapeutic recommendations of the Global Implementation Guidelines on Heart Failure pertain to evolving data on the soluble guanylate cyclase stimulator vericiguat, cardiac glycosides, GLP-1 receptor agonists, cardiac myosin inhibitors, and preventive vaccination strategies. Revised recommendations were informed by recently published randomized trials, and selected additional post-hoc analyses and meta-analyses demonstrating improvements in symptoms, quality of life, HF hospitalization or mortality among patients receiving contemporary guideline-directed medical therapy (GDMT) regarding the approaches mentioned above. Consistent with the overarching iCARDIO Alliance framework, these recommendations additionally consider the feasibility, monitoring requirements, multidisciplinary expertise, and globally varying levels of healthcare resources. In selected cases, specific implementation guidance is provided for settings in which resources are somewhat limited or severely limited. Accordingly, this document provides a concise, evidence-informed, and globally applicable focused update to HF management strategies, aiming to support clinicians in optimizing HF care and improving patient outcomes across a broad range of healthcare systems worldwide.