ESC Universal Heart Failure Algorithm (2023 Guideline Integration Tool)

Age (years)

Left Ventricular Ejection Fraction (LVEF, %)

NYHA class

Systolic blood pressure (mmHg)

Heart rate (bpm)

eGFR (mL/min/1.73m²)

Serum potassium (mmol/L)

Diabetes mellitus

Currently congested / symptomatic fluid overload?

Atrial fibrillation present?

QRS duration (ms)

Left bundle branch block (LBBB)?

ESC Universal Heart Failure Algorithm (2023 Guideline Integration Tool)
This integration tool translates the 2023 focused update of the ESC heart failure guidance into a pragmatic bedside checklist and decision aid. It helps clinicians classify phenotype (HFrEF, HFmrEF, HFpEF), check haemodynamic and renal constraints, and assemble the core therapeutic package: ARNI/ACEi/ARB, beta-blocker, MRA, and SGLT2 inhibitors where indicated; use diuretics for congestion; consider specialist referral for ivabradine, device therapy (CRT/ICD) and advanced therapies when patients remain symptomatic despite optimal therapy.

Clinical significance: The 2023 focused update reinforced early and combined use of evidence-based therapies (including SGLT2 inhibitors across ejection fraction ranges and earlier ARNI use in appropriate patients) and highlighted implementation and sequencing considerations for real-world practice. The tool is intended as an integration aid and educational companion — it does not replace individualized clinical judgement, local formularies, or specialist consultation for complex cases.

Reference:
European Society of Cardiology (ESC). 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure — full text and focused update summary.

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