Pumping Marvellous Foundation Heart Failure Brief — 7th September 2026

The major development in recent weeks is the publication of the full 2026 European Society of Cardiology (ESC) heart failure guidelines, accompanied by the ESC’s first dedicated cardiac rehabilitation guidelines. Together, they strengthen our arguments around prevention, patient participation, rehabilitation access and flexible community delivery.

1. New ESC heart failure guidelines move prevention and early intervention to the centre

Published on 28th August 2026, the guidelines replace the 2021 edition and incorporate the 2023 focused update.

Key changes include:

• A stage A–D model spanning people at risk through to advanced heart failure.
• Greater emphasis on preventing progression and beginning treatment early.
• Two principal EF phenotypes, rather than three: HFrEF below 50% and HFpEF at or above 50%; the separate “mildly reduced” category is removed.
• “Acute heart failure” is replaced by the more precise term “decompensated heart failure.”
• New treatment language distinguishing foundational medical therapy, additional medical therapy and guideline-directed interventional therapy.
• A Class I recommendation for mineralocorticoid receptor antagonists in chronic HF irrespective of EF.
• A Class IIa recommendation for semaglutide or tirzepatide in people with HFpEF and obesity.
• Dedicated attention to education, self-care, shared decision-making and multidisciplinary care.

What has genuinely changed: This is formal international clinical guidance. Heart failure is now framed more explicitly as a preventable and modifiable continuum rather than a condition addressed only after symptoms and decompensation appear.

Evidence strength: Comprehensive multidisciplinary guideline evaluation using the ESC’s revised approach to interpreting evidence.

Limitations applicable to the UK: ESC guidance does not itself alter NICE / SMC recommendations or NHS commissioning. The simplified ejection Fraction division may initially create coding, audit and pathway ambiguity in UK services still using HFrEF/HFmrEF/HFpEF categories.

Why it matters to the Pumping Marvellous Foundation: The stage based framework gives PMF a stronger policy platform for BEAT awareness, earlier case-finding and BEAT to TREAT. It also supports our argument that education and self-management are components of evidence-based care—not optional charitable additions. Full ESC guideline and supporting resources, official summary of changes

2. Digital and hybrid cardiac rehabilitation now have explicit guideline standing

The ESC has published its first comprehensive cardiac-rehabilitation guideline. For people with heart failure, cardiac telerehabilitation or hybrid rehabilitation should be considered as alternatives to centre-based care to improve exercise capacity, six-minute walking distance and health-related quality of life—a Class IIa, level B1 recommendation.

The guidance also says:

• Delivery should be selected through shared decision-making.
• Patient-centred combinations of face-to-face, virtual and remote rehabilitation should be considered to improve participation and equity.
• Digital delivery must retain the core components of rehabilitation.
• The rehabilitation team remains clinically responsible, regardless of delivery mode.
• Assessment, risk stratification and pre-exercise screening still require appropriate clinical oversight.

What has genuinely changed: Digital and hybrid rehabilitation have progressed from promising service options to explicitly recognised delivery models within formal European guidance.

Evidence strength: Guideline synthesis drawing on randomised trials, systematic reviews and meta-analyses; the HF recommendation carries moderate evidential support.

Limitations: Trials are generally small, heterogeneous and followed patients for no more than 12 months. Evidence on long-term clinical outcomes, multimorbidity, safety, costeffectiveness and underserved populations remains incomplete.

Why it matters to the Pumping Marvellous Foundation: This directly reinforces the strategic case for PMF’s free digital cardiac-rehabilitation platform. NHS partners can no longer reasonably frame digital provision simply as an inferior substitute for centre-based services. The stronger proposition is a clinically governed, patient-chosen route that extends reach while preserving rehabilitation standards. 2026 ESC cardiac-rehabilitation guideline, ESC patient versions

3. AI-ECG detection is promising

An AI model presented at ESC Congress reportedly analysed routine ECGs in under two seconds and identified up to 81% of heart-failure cases and 90% of valvular disease cases in a US dataset of approximately 67,000 patients.

The proposed use is triage: identifying people who should be prioritised for echocardiography, not replacing clinical assessment, NT-proBNP or imaging.

However, sounds promising as an addition to SOP.

What is new: The scale and apparent speed strengthen the case for extracting diagnostic signals from tests already used throughout health services.

Evidence strength: Large validation population and a low-cost, widely available input test.

Limitations: Detailed peer-reviewed results and operating thresholds were not readily available with the congress announcement. Sensitivity alone does not establish positive predictive value, health-economic benefit or clinical utility. Performance in UK primary care, across ethnic groups and in HFpEF must be demonstrated prospectively.

Why it matters to the Pumping Marvellous Foundation: AI-ECG could eventually become an additional front door into the BEAT to TREAT pathway, particularly where echo capacity is constrained. We will not adopt the “AI diagnoses HF in two seconds” messaging: its credible role is to be an adjunct to prioritise people for definitive investigation. ESC Congress report

Heart failure watchlist

• NICE / SMC response to the revised ESC classifications and therapy recommendations
• Whether NHS audit definitions change following removal of the HFmrEF category
• How services implement expanded MRA use and GLP-1 therapy safely and equitably
• Full publication and UK validation of the AI-ECG findings
• Whether ICBs translate the new rehabilitation guidance into referral, access and uptake targets rather than acknowledging it without changing delivery