# Heart failure evidence update 2026

## TL;DR

New evidence since 2021 has significantly expanded heart failure treatment options across all ejection fraction levels.

## Contribution

The paper highlights major therapeutic advances and their potential to reshape clinical practice.

## Key findings

- Non-steroidal mineralocorticoid receptor antagonists and incretin-based therapies show promise for HF with preserved EF.
- Rapid guideline-directed medical therapy optimization is effective in acute heart failure.
- Digitalis glycosides have new supporting evidence for patients with reduced EF.

## Abstract

The interval since the 2021 European Society of Cardiology (ESC) Guidelines and 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) Guidelines publications has witnessed an unprecedented volume of evidence that substantially expands the therapeutic landscape across the entire ejection fraction (EF) spectrum. Major developments include the emergence of non-steroidal mineralocorticoid receptor antagonists and incretin-based therapies for heart failure (HF) with mildly reduced and preserved EF, the validation of rapid guideline-directed medical therapy optimization strategies in acute HF, and new evidence supporting digitalis glycosides in HF patients with reduced EF. Device-based care has evolved with transcatheter edge-to-edge repair for valvular heart disease. These data are likely to reshape contemporary clinical practice.