ESC Universal Heart Failure Algorithm (2023 Guideline Integration Tool)

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.