In brief
At the end of August 2026 the European Society of Cardiology (ESC) published several updated guidelines at once. Here I explain which of the changes affect practice — and what patients should know.
For the first time, dedicated guidelines have been issued on managing patients with cardiovascular disease and chronic kidney disease, prepared jointly with the European Renal Association. The central idea: the kidneys and the heart are communicating vessels, and disease of one organ sharply worsens the outlook for the other.
The practical conclusion: all patients with heart disease are advised to have their kidney function checked — a blood creatinine test with calculation of the glomerular filtration rate, and a urine albumin test. Both tests are cheap and quick, yet for years they have been underused. An early finding changes management: some familiar drugs need a dose adjustment, while others, on the contrary, protect the kidneys.
The updated heart failure guidelines introduce stages — from stage A (the person is still healthy but has risk factors: hypertension, diabetes, obesity) to advanced stage D. The point is to intervene before symptoms appear, not after.
The classification has changed too: instead of three categories by ejection fraction there are now two — reduced (below 50%) and preserved (50% and above). The intermediate category was removed: it turned out that these patients benefit from the same treatment as those with reduced ejection fraction. The term "acute heart failure" has been replaced with "decompensated", which reflects the nature of the condition more accurately: it usually worsens gradually rather than suddenly.
A notable development: semaglutide and tirzepatide — the very drugs the public knows as weight-loss medicines — have received a class IIa recommendation for patients with heart failure with preserved ejection fraction and obesity. This is not "a slimming pill on a cardiologist's orders", but recognition that in a specific group of patients, weight loss measurably improves the course of heart disease.
An important caveat: this is a recommendation for selected patients with a confirmed diagnosis, not for anyone who wants it. Prescription only after assessment.
The Fifth Universal Definition of Myocardial Infarction has been published — a joint document of the ESC, the American College of Cardiology, the American Heart Association and the World Heart Federation. Myocardial infarction is now divided into three clinical types: primary (thrombosis in a coronary artery itself), secondary (when the heart is short of oxygen because of another illness — sepsis, severe anaemia) and procedure-related.
For patients, something else matters more: the document establishes separate troponin thresholds for men and women. Troponin is the protein used to diagnose a heart attack, and its normal values are lower in women. A single threshold meant that some heart attacks in women were not recognised in time. This bias has now been corrected at the level of an international standard.
Dedicated cardiac rehabilitation guidelines have appeared for the first time, and its indications have been broadened: not only recovery after a heart attack, but also congenital heart defects, atrial fibrillation, the period after valve replacement and cardiac complications of chemotherapy. The proven benefit lies not only in a lower risk of repeat events, but also in quality of life, exercise tolerance and psychological wellbeing.
If you have hypertension, diabetes, excess weight or an established heart diagnosis, ask your doctor to check not only your heart but also your kidneys. If you are a woman and have ever been told that your "troponin is borderline but within normal limits", that is a reason to discuss the result again. And if you have risk factors but nothing troubles you, you are in exactly that stage A where prevention works best.
At GMS a cardiology consultation is AED 750; ECG and echocardiography are performed in the clinic, and their results are discussed at the appointment. Blood and urine samples are taken in the clinic, and we go over the findings at a free follow-up visit once the results are ready. For planned assessment there are check-up programmes.
Joint guidelines on heart and kidney disease, updated heart failure guidelines with stages A to D, the Fifth Universal Definition of Myocardial Infarction with separate troponin thresholds for men and women, dedicated cardiac rehabilitation guidelines, and a class IIa recommendation for semaglutide and tirzepatide in selected patients.
The kidneys and the heart are communicating vessels: disease of one sharply worsens the outlook for the other. All patients with heart disease are therefore advised to have blood creatinine with calculated filtration rate and a urine albumin test. An early finding changes management: some drugs need a dose adjustment, others protect the kidneys.
Semaglutide and tirzepatide have received a class IIa recommendation for patients with heart failure with preserved ejection fraction and obesity. This applies to selected patients with a confirmed diagnosis, not to anyone who wants it, and prescription follows assessment.
This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.
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