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News
The European Society of Cardiology just dropped a major update to its heart failure guidelines — and the changes are significant. The "mildly reduced" LVEF phenotype is gone, leaving just two: preserved (≥50%) and reduced (<50%). A new four-stage classification system now emphasizes earlier intervention and prevention, while "guideline-directed medical therapy" gets rebranded as "foundational medical therapy."
The European Society of Cardiology (ESC) has released sweeping updates to its heart failure (HF) guidelines, reshaping how clinicians classify and treat the condition. The most notable change: the elimination of the "mildly reduced" ejection fraction phenotype, leaving just two — preserved (LVEF ≥50%) and reduced (LVEF <50%). Experts note the old middle category was confusing and poorly supported by evidence, and that these patients share similar pathophysiology and treatment responses with the reduced group.
The new guidelines also introduce a four-stage classification system — Stage A (at-risk), Stage B (pre-HF), Stage C (symptomatic), and Stage D (advanced) — adopted from the 2022 AHA/ACC/HFSA guidelines. "Guideline-directed medical therapy" (GDMT) is rebranded as "foundational medical therapy" (FMT), with many treatments pushed earlier in the disease course. A new "additional medical therapies" (AMT) category covers interventions that improve quality of life or reduce events on top of FMT.
Key Takeaways:
Why it matters: These guidelines push heart failure management earlier and make treatment pathways clearer for clinicians — potentially preventing or slowing disease progression in at-risk patients.
