Europe's cardiologists issued three new guidelines at once, two of them firsts

The European Society of Cardiology released three new clinical practice guidelines on 28 August, the opening day of its congress in Munich, alongside the Fifth Universal Definition of Myocardial Infarction [s4] [s5] [s6] [s7]. All three were published in the European Heart Journal the same day [s1] [s2] [s3].

Two of them are first editions. That is the more significant fact than any individual recommendation, because a first-edition guideline stakes out territory that European cardiology had not previously claimed as its own.

Heart failure: a reclassification, and a vocabulary change

The heart failure guidelines are an update, and the ESC describes their changes in terms of how the condition is sorted rather than what is prescribed for it [s4].

Two classification changes are named. The guidelines refine the classification of heart failure according to left ventricular ejection fraction, with the stated aim of making it easier to apply in practice, and they introduce a stage-based classification that places greater emphasis on disease prevention, early recognition and timely intervention [s4].

A stage-based scheme is a different object from an ejection-fraction category. Ejection fraction sorts patients who already have heart failure by how well the ventricle empties; a stage-based system extends backwards to people who do not yet have the syndrome but are on a trajectory towards it. Building that into a European guideline moves heart failure some distance towards being managed as a preventable condition rather than a diagnosed one.

The guidelines also propose a revised nomenclature for heart failure therapies, which the ESC says is intended to provide greater clarity [s4], and update treatment indications on the basis of new evidence, taking into account new ESC guidance on how evidence should be interpreted [s4]. That last clause is easy to skim past: it means at least some indication changes follow from a change in the appraisal method, not only from new trials.

The document's first listed author is Lars Køber [s1].

Cardiovascular disease and chronic kidney disease: STAMP

This is the first ESC guideline dedicated to the management of cardiovascular disease together with chronic kidney disease, developed in collaboration with the European Renal Association [s2] [s5].

Its organising device is an acronym, STAMP: Screen, Triage and Address CKD risk; Modify CVD management; Plan health services [s5]. The ESC's own summary is explicit about who the first three letters are aimed at — all clinicians, including the cardiology community, are asked to engage actively in identifying chronic kidney disease and starting cost-effective interventions to manage it [s5].

That is a boundary being redrawn. Screening for and treating kidney disease has not conventionally been framed as a cardiologist's job.

The justification the guideline offers is the strength of association between chronic kidney disease and a long list of cardiovascular conditions: acute and chronic coronary syndromes, heart failure, arrhythmias, stroke, peripheral arterial disease and sudden cardiac death [s5]. The M in STAMP covers all of them, flagging where the presence of kidney disease requires a change to standard cardiovascular management or additional measures [s5]. The document also includes recommendations aimed at ensuring patients with chronic kidney disease are not subject to delays in cardiological treatment despite their added complexity [s5].

Its first listed author is Kevin Damman [s2].

Cardiac rehabilitation: the first ESC guideline on it

Cardiac rehabilitation has long carried a strong evidence base and weak uptake. The ESC's first guideline on it sets out to define the service rather than to argue for it.

The document provides guidance on the indications for cardiac rehabilitation and the management of patients in Phase II programmes, covering infrastructure requirements, staff composition, core components, delivery methods, care goal setting and outcome assessments [s6]. Its recommendations apply to adults with cardiac diseases, and to patients with cancer undergoing or recovering from cardiotoxic therapies [s6].

The inclusion of oncology patients is the notable extension. Cardio-oncology has been growing as a subspecialty, and this places rehabilitation for cancer-treatment cardiotoxicity inside the same guideline as rehabilitation after a heart attack.

The specification of infrastructure and staffing is the other thing to note. Guidelines usually tell clinicians what to do; a guideline that describes what a service must contain is aimed at the people who commission and fund it.

Its first listed author is Maria Bäck [s3].

What can and cannot be verified here

A caveat this article has to carry. The full texts of all three guidelines are published in the European Heart Journal behind a subscription [s1] [s2] [s3]. The summaries above come from the ESC's own public descriptions of each document [s4] [s5] [s6], not from reading the recommendation tables.

That means no specific recommendation, class of recommendation or level of evidence is reported here. What the ESC says a guideline changes and what its recommendation tables actually say are different kinds of statement, and only the first was available to check.

The society ran a dedicated press session on the new guidelines and the Fifth Universal Definition on 28 August, with the task force chairs available for interview [s7].

What to watch

Whether national cardiac societies adopt the stage-based heart failure classification, since a classification only changes practice once it is embedded in local pathways and coding. And whether the STAMP framing produces measurable change in how often cardiology services screen for kidney disease — the guideline's own premise is that they currently do not do it enough [s5].

This article describes clinical guidance documents. It is not medical advice, and nothing here should be used to make decisions about care.

Sources

• 2026 ESC Guidelines for the management of heart failure, European Heart Journal, 28 August 2026
• 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association (ERA), European Heart Journal, 28 August 2026
• 2026 ESC Guidelines on cardiac rehabilitation, European Heart Journal, 28 August 2026
• 2026 Heart Failure - ESC Clinical Practice Guidelines, European Society of Cardiology, 28 August 2026
• 2026 CVD and CKD - ESC Clinical Practice Guidelines, European Society of Cardiology, 28 August 2026
• 2026 Cardiac Rehabilitation - ESC Clinical Practice Guidelines, European Society of Cardiology, 28 August 2026
• Get ready for ESC Congress 2026, European Society of Cardiology, 19 August 2026