Renewed heart failure guidelines drop the mildly reduced ejection fraction category, the share of blood the left ventricle pumps, and keep two phenotypes: below 50 per cent, and 50 per cent or above. Acute heart failure is renamed decompensated. Mineralocorticoid receptor antagonists carry a Class I recommendation at every ejection fraction. Nurse-led teams in India left 84.0 per cent of patients alive and out of hospital over two years against 79.4 per cent under usual care.
The renewed heart failure guidelines move to an A-D staging that runs from prevention to advanced management. The mildly reduced ejection fraction category, the share of blood the left ventricle pumps, is gone, leaving two phenotypes: left ventricular ejection fraction below 50 per cent, and 50 per cent or above. The term acute heart failure has been replaced by decompensated heart failure.[1]
Therapy naming changed too: classes of foundational, additional and guideline-directed interventional therapy replace the broader abbreviation. Mineralocorticoid receptor antagonists carry a Class I recommendation for chronic heart failure at every ejection fraction, and semaglutide or tirzepatide reach Class IIa for patients with preserved ejection fraction and obesity. Recommendations for digoxin, mechanical circulatory support and mitral valve repair were upgraded.[1]
Proven heart failure drugs often fail to reach patients in everyday practice. With a team-based model coordinated by nurses in India, the share of adults whose left ventricle pumped 40 per cent of its blood or less who were alive and free of hospital admission over two years was 84.0 per cent, against 79.4 per cent under usual care. Deaths were 22 per cent lower in the team-model hospitals. The investigators describe the gap between guideline advice and routine practice as the target of the model.[2]
