The American College of Cardiology (ACC) just released an update its expert consensus decision pathway, Management of Heart Failure with Preserved Ejection Fraction. Advances in effective interventions, including sodium glucose-cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, among others, motivated the ACC to release this 2026 update, replacing the 2023 version.

Today, we’re outlining some of the key changes between the previous 2023 version and this latest version. For the complete look at the ACC expert consensus decision pathway on heart failure with preserved ejection fraction (HFpEF), view the full-text version.

Key Changes in the 2026 ACC HFpEF Update:
  • The Pathway Summary Graphic (figure 1) was revised with emphasis on key components of HFpEF management. These components include identifying symptoms and signs, assessing for HFpEF noncardiac- and cardiac mimics, and implementing an HFpEF management plan. The pathway summary graphic now places ongoing emphasis on the role of multidisciplinary collaboration for optimal care.
  • The HF Diagnostic Scores (table 1 [new], figure 3[revised]) were modified to include the addition of the HFpEF-ABA score, which was published after the previous version of the expert consensus decision pathway. The new table summarizes the use of the three available scoring methods. 
  • The HFpEF Mimics (table 2 [revised), figure 4 [revised]) was expanded to emphasize the critical importance of assessing HFpEF mimics to avoid missed opportunities for disease-directed therapy to improve patient outcomes. The noncardiac section was expanded to include high-output heart failure and the addition of frailty, deconditioning, and obesity. The cardiac section was expanded to include ischemic heart disease. 
  • Sex-Specific Considerations (figure 5) was moved to a standalone subsection in the diagnosis section and now includes emerging evidence and additional detail, emphasizing the expanding knowledge on sex-specific considerations and the need for future investigations.
  • Optimal Medical Therapy (tables 3, 4, and 5, figure 6) was updated to include pivotal advances in optimal medical therapy, notably with sodium glucose-cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and incretin-based therapies. 
  • Nonpharmacologic Management (table 3) was expanded and now includes new trials of nonpharmacologic management, including pacing, atrial shunt devices, and sphlanic nerve stimulation.
  • Comorbidities (figure 8 [revised], figure 9 [new]) was updated to reflect the evolution in understanding CKM syndrome and its impact on the management of HFpEF comorbidities. The new figure summarizes how clinicians should view overlapping indications and benefits of CKM therapies.

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