Presented in Munich on 28 August 2026 and published in the European Heart Journal: the first full revision of the ESC heart failure guideline since 2021. HFmrEF disappears (HFrEF now means LVEF below 50 percent, HFpEF 50 percent and above), a stage A to D framework puts prevention on the map, 'acute' becomes 'decompensated', and GDMT is replaced by foundational, additional and interventional therapy. New class I recommendations: an MRA for symptomatic HF regardless of LVEF (finerenone for HFpEF), in-hospital SGLT2 inhibitor start after stabilisation, uptitration every 1 to 2 weeks, IV iron, early advanced-HF referral and palliative care access. Class IIa: semaglutide or tirzepatide for HF with LVEF 45 percent or higher and BMI 30 or higher, digoxin or digitoxin for symptomatic HFrEF. Four Dutch task force members.
