2026 iCARDIO Alliance Global Implementation Guidelines on Heart Failure

This is the updated 2026 version of the iCARDIO Alliance Global Implementation Guidelines on Heart Failure – originally published in 2025. In these guidelines, we aim to consider inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues that restrict the global applicability of currently available guidelines. There is a need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as HF with improved ejection fraction and cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such "economic adjustment" recommendations aim to provide guidance for situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents not only a comprehensive but also concise set of recommendations to guide all aspects of HF management with a unified strategy for the pharmacological, non-pharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.