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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.