A patient-friendly summary of the key messages from ESC Congress 2026 in Munich
| In one sentence: the new documents shift the focus towards earlier detection, a simpler heart failure classification, protection of the heart and kidneys as an interconnected system, cardiac rehabilitation as an integral part of care, and a more precise explanation of the cause of myocardial infarction. |
At the annual congress of the European Society of Cardiology (ESC), held in Munich from 28 to 31 August 2026, three new clinical practice guidelines and the Fifth Universal Definition of Myocardial Infarction were presented. These recommendations will directly influence the everyday assessment and treatment of a large number of patients – from people who have no symptoms but are at increased risk, to patients following a myocardial infarction, those with heart failure, and those living with both cardiovascular and kidney disease.
The common thread running through all these documents is clear: do not wait for advanced disease. Identify risk earlier, begin treatment in a timely manner and involve the patient in shared decision-making.
1. Heart Failure: A Simpler Classification and Earlier Treatment
The new ESC Guidelines for the management of heart failure introduce a stage-based approach – from people with risk factors, through preclinical cardiac changes, to symptomatic and advanced heart failure. Prevention therefore receives the same emphasis as the treatment of established disease. High blood pressure, diabetes, obesity, coronary artery disease, kidney disease and cardiac arrhythmias are no longer viewed merely as accompanying conditions, but as opportunities for intervention before breathlessness, swelling and fatigue appear.
Two Groups According to Ejection Fraction
The previous division into heart failure with reduced, mildly reduced and preserved ejection fraction has been simplified. The Guidelines now distinguish heart failure with a left ventricular ejection fraction below 50% from heart failure with an ejection fraction of 50% or higher. The reason is practical: patients in the former ‘intermediate’ group often have similar disease mechanisms and derive similar treatment benefits to patients with reduced cardiac function.
It is important to emphasise that a normal ejection fraction does not exclude heart failure. The diagnosis is made by linking symptoms and signs with the findings of echocardiography, natriuretic peptide testing, electrocardiography and other investigations. Parameters such as diastolic function, left atrial size and myocardial strain can help identify abnormalities at an earlier stage.
New Treatment Terminology
The sometimes imprecise term ‘guideline-directed medical therapy’ has been replaced by three clearer categories: foundational medical therapy, supported by the strongest evidence; additional medical therapy for specific patient groups or symptoms; and guideline-directed interventional therapy, including devices and procedures. This framework is intended to facilitate individualised treatment and allow recommendations to evolve rapidly as new evidence emerges.
Highlighted changes include stronger recommendations for mineralocorticoid receptor antagonists in chronic heart failure irrespective of ejection fraction, as well as the option of semaglutide or tirzepatide in selected patients with preserved ejection fraction and obesity. Recommendations have also been upgraded for certain additional medicines, durable mechanical circulatory support and transcatheter treatment of mitral regurgitation. Treatment selection must nevertheless always take account of the clinical presentation, blood pressure, kidney function, potassium level and coexisting conditions.
| What does this mean for the patient? Follow-up appointments are important even when no symptoms are present. Timely blood pressure measurement, laboratory assessment, ECG and echocardiography can identify risk or early changes before advanced heart failure develops. |
2. Cardiac Rehabilitation Becomes an Integral Part of Treatment
For the first time, the ESC has published dedicated, comprehensive Guidelines on cardiac rehabilitation. This sends an important message: recovery following a myocardial infarction, cardiac surgery or worsening heart disease does not end at hospital discharge or with the prescription of medication.
A high-quality rehabilitation programme is delivered by a multidisciplinary team and includes individually prescribed exercise, management of risk factors, correct use of medication, nutritional guidance, smoking cessation, psychological support and a plan for returning to everyday activities. The goal is not only improved physical fitness, but also fewer recurrent cardiovascular events, greater confidence, restored independence and a better quality of life.
Cardiac rehabilitation is recommended after myocardial infarction and in heart failure, while patients with atrial fibrillation, congenital heart disease, those who have undergone heart valve replacement, and people treated with potentially cardiotoxic cancer therapies may also benefit. For selected patients, digitally supported home-based programmes with remote monitoring and teleconsultations may be appropriate.
| Key message: cardiac rehabilitation is not an optional addition but part of treatment. The programme should be tailored to each person’s medical condition, abilities, goals and life circumstances. |
3. The Heart and Kidneys Must Be Assessed Together
The first ESC Guidelines specifically dedicated to the management of cardiovascular disease in patients with chronic kidney disease were developed in collaboration with the European Renal Association. They emphasise that heart disease can accelerate kidney damage, while chronic kidney disease substantially increases the risk of heart failure, myocardial infarction, arrhythmias, stroke and sudden cardiac death.
The practical framework known as STAMP on CKD covers screening, triage and risk assessment, early action to address risk, modification of cardiovascular management, and planning of healthcare services. The most important change for everyday practice is the recommendation that patients with cardiovascular disease should be assessed for kidney disease using both blood and urine tests: estimated glomerular filtration rate (eGFR) and the urine albumin-to-creatinine ratio (UACR). Serum creatinine alone is not always sufficient.
The Guidelines support the early use of proven therapies that protect both the heart and kidneys, including renin-angiotensin system inhibitors, SGLT2 inhibitors and statin-based therapy, when indicated and safe for the individual patient. They also emphasise dose adjustment according to kidney function, electrolyte monitoring, and close collaboration between cardiologists, nephrologists and primary care physicians.
4. A New Definition of Myocardial Infarction: The Cause Matters, Not Only the Number
The Fifth Universal Definition of Myocardial Infarction, a joint document from the ESC, ACC, AHA and World Heart Federation, replaces the previous numerical classification with three clinically more meaningful categories: primary, secondary and procedure-related myocardial infarction.
Primary myocardial infarction results from an acute problem in a coronary artery – most often rupture of an atherosclerotic plaque, but also spontaneous coronary artery dissection, coronary spasm or thrombosis. Secondary myocardial infarction occurs when myocardial oxygen demand exceeds oxygen supply because of another serious condition, such as a very rapid heart rate, markedly high or low blood pressure, anaemia or severe hypoxaemia. A procedure-related myocardial infarction occurs in temporal association with a cardiac procedure or operation.
An elevated troponin level indicates myocardial injury, but does not automatically establish a diagnosis of myocardial infarction. Diagnosis requires an appropriate rise or fall in troponin together with clinical evidence of myocardial ischaemia, such as typical symptoms, ECG changes or relevant imaging findings. The new definition incorporates sex-specific troponin thresholds and encourages the use of imaging to clarify the cause of myocardial injury.
| Why does this matter? Identifying the precise cause leads to more precise treatment. Management of a primary myocardial infarction caused by an occluded artery is not the same as treatment of a secondary myocardial infarction triggered by severe anaemia, a rapid heart rhythm or a blood pressure disorder. |
What Do All the New Guidelines Have in Common?
Although they address different topics, the new documents share several important messages:
prevention and early detection must begin before severe symptoms develop;
treatment should be tailored to the patient’s phenotype, comorbidities and the true mechanism of disease;
the heart, kidneys, metabolism, physical capacity and mental health should be viewed as interconnected;
rehabilitation, education and self-care deserve the same attention as medication and procedures;
decisions should be made together with the patient, with regular monitoring of treatment effectiveness and safety.
When Should You Not Wait for a Routine Appointment?
Urgent medical assessment is required for new or severe chest pain or pressure, sudden shortness of breath, cold sweating, nausea, loss of consciousness, new weakness on one side of the body, or a sudden deterioration in general condition. Patients with known heart failure should also seek earlier assessment if they experience rapid weight gain, increasing swelling, breathlessness at rest, or the need to sleep propped up on additional pillows.
A Message from Dr Mačkić Practice
The new ESC Guidelines do more than change names and tables – they change the point at which we act. Their greatest benefit is achieved when an individual’s risk is recognised early, the diagnosis is confirmed with appropriate tests and treatment is monitored over time. A cardiology consultation, ECG, contemporary echocardiography, assessment of kidney function and albuminuria, and targeted laboratory monitoring allow the recommendations to be applied to the individual patient rather than to the diagnosis alone.
This article is provided for general information and cannot replace a medical consultation or an individual treatment plan. Medication should not be started, changed or discontinued without consulting a physician.
Official Sources
ESC: 2026 ESC Guidelines for the management of heart failure – https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/heart-failure/
ESC: 2026 ESC Guidelines on Cardiac Rehabilitation – https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/cardiac-rehabilitation/
ESC: 2026 ESC Guidelines for cardiovascular disease and chronic kidney disease – https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/cvd-chronic-kidney-disease/
ESC: Fifth Universal Definition of Myocardial Infarction (2026) – https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/fifth-universal-definition-myocardial-infarction/