Draft Document for Public Consultation: What is new and what has changed in the 2026 Global Heart Failure Implementation Guidelines and why

2026 iCARDIO Alliance Global Implementation Guidelines on Heart Failure

Inequities in healthcare access, infrastructure, resource availability, differing society recommendations, and local clinical practices continue to limit the global applicability and implementation of existing heart failure (HF) guidelines. Accordingly, there remains a need for concise and practical recommendations that address the diverse challenges faced by patients and healthcare providers in different areas of the world. The iCARDIO Alliance Global Implementation Guidelines aim to ntegrate contemporary evidence on heart failure diagnosis and treatment with implementation considerations applicable across diverse economic and healthcare settings. 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 and diagnostically move from the HFrEF to the HFpEF category they are commonly diagnosed as having HF with improved EF (HFimpEF). Hence, we now 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 [...]