Heart failure & cardiomyopathiesMeta-analysis
Heart failure with reduced ejection fraction: a systematic review of clinical practice guidelines and recommendations
- systematic review of guidelines
Authors' conclusion
Our findings underscore the need for greater harmonization to standardize and optimize HFrEF care worldwide.
Study context
- Population
- Clinical practice guidelines on the diagnosis and management of heart failure with reduced ejection fraction (HFrEF) in adultsguidelines identified, of which seven met predefined AGREE II criteria for methodological ‘rigour of development’ and were included in the final analysis
- Participants
- Twelve guidelines
Pooled result
As reported in the abstract
Consensus across guidelines
- Broad consensus on the prevention of heart failure, the definition of HFrEF, and the initial diagnostic approach
- Recommended investigations included coronary CT angiography, cardiac magnetic resonance imaging, and invasive coronary angiography in selected patients
- Consistent endorsement of foundational therapies such as renin-angiotensin-aldosterone system (RAAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors
Further pooled results
Differences across guidelines
- Key differences regarding thresholds for serum natriuretic peptides, sequencing of RAAS inhibitors, and device-based therapies including implantable defibrillators in non-ischaemic HFrEF, cardiac resynchronization therapy, and indications for coronary revascularization
- Variability in staging, particularly the identification and management of stage A (at-risk) and stage B (pre-heart failure)
- Only a minority of guidelines addressed common comorbidities such as iron deficiency, atrial fibrillation, obesity, sleep-disordered breathing, and frailty
Original publication
Heart failure with reduced ejection fraction: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes. Published 4 March 2026. doi:10.1093/ehjqcco/qcag029
Summarised from the published abstract; every number is checked against it