New Guideline-Directed Treatments for Heart Failure: Navigating Through the Multiple Turns of Everyday Clinical Practice

The new European guidelines for the treatment and management of heart failure (HF) introduce several new recommendations. The revised HF definition has abolished the term "mid-range," introducing the new concept of "mildly reduced" ejection fraction (EF), which now deserves consideration for therapies previously confined to reduced EF (HF with reduced EF). Following the introduction of sodium-glucose cotransporter 2 inhibitors, physicians should now combine up to 4 different drugs to improve HF with reduced EF prognosis, leading to new issues regarding tolerance and adherence to therapy. Transcatheter treatments of mitral and tricuspid regurgitation are progressively gaining increasing consideration among nonpharmacological strategies. Dedicated therapies for HF with preserved EF are still lacking. These are only some of the most relevant changes provided by European guidelines on HF that are addressed in the present editorial, taking into account the most updated American recommendations.