European cardiology group recommends semaglutide and tirzepatide for a type of heart failure

The European Society of Cardiology's updated heart failure guidelines recommend semaglutide and tirzepatide for patients who have heart failure with preserved ejection fraction (HFpEF) together with obesity, the society announced at its 2026 Congress in Munich ^[1].

The recommendation names Novo Nordisk's GLP-1 agonist semaglutide — sold in the United States as Ozempic, Wegovy and Rybelsus — and Eli Lilly's dual GIP/GLP-1 agonist tirzepatide, sold as Mounjaro and Zepbound ^[1].

How the guidelines redraw heart failure

The update's headline change is how heart failure is sorted by left ventricular ejection fraction (LVEF), a measure of how much blood the heart's main chamber pumps out with each beat ^[1]. The category known as heart failure with mildly reduced ejection fraction is gone. Patients are now grouped as either heart failure with reduced ejection fraction (HFrEF), defined as an LVEF of 50% or less, or heart failure with preserved ejection fraction (HFpEF), defined as an LVEF above 50% ^[1].

The same update backs mineralocorticoid receptor antagonists, including Bayer's Kerendia (finerenone), in chronic heart failure independent of LVEF ^[1]. Under the earlier system, treatment recommendations were tied more tightly to where a patient fell on the ejection fraction scale.

A new way to classify heart attacks

The Munich congress also introduced a new universal definition of myocardial infarction, or MI, replacing the numerical system that sorted heart attacks into types 1 through 5 ^[1]. The new framework uses three categories: primary MI, covering spontaneous acute coronary problems such as atherothrombosis, vasospasm, or spontaneous coronary artery dissection (SCAD), a sudden tear in the artery wall; secondary MI, where another acute illness such as severe anemia, respiratory failure or sudden blood loss is the cause; and procedure-related MI occurring within 30 days of a cardiac intervention ^[1].

The classification was developed by the ESC together with the American College of Cardiology, the American Heart Association and the World Heart Federation ^[1]. It introduces lower, gender-specific thresholds for troponin, a biomarker of heart damage, and encourages precise coronary imaging for non-clot heart attacks ^[1]. SCAD is up to nine times more common in women than in men, and the society said it is underdiagnosed and can lead to inappropriate treatment ^[1].

"People may think of an MI as a heart attack caused by a blocked coronary artery, but there are many different causes," ESC Chair Prof Nicholas Mills of the University of Edinburgh told delegates ^[1]. He said the previous numerical system was "not always easy to apply in clinical practice, leading to inconsistencies in diagnosis and treatment" ^[1].

Why it matters for patients

Guidelines tell doctors what a major medical society considers appropriate care; they are not the same thing as regulatory approval. This update changes what European cardiologists are advised to consider for two large groups of patients — those with HFpEF and obesity, and anyone being sorted into a heart failure or heart attack category.

For Americans, the practical reach is unclear. Whether US prescribing information for semaglutide or tirzepatide includes an HFpEF indication has not been reported, and no change to US labeling was disclosed at the congress ^[1]. A recommendation from a European body does not obligate US clinicians, pharmacies or insurers to follow it, and the reporting does not say whether or how US insurers would cover either drug for this use.

Two details may matter to people who already take these medicines or are discussing them. First, the HFpEF recommendation is tied to having obesity, not to heart failure alone ^[1]. Second, weight-loss and diabetes drugs are commonly prescribed at different doses for different purposes, and the guidelines' specific dosing guidance was not reported ^[1].

What happens next

A date for publication of the full guideline documents, and any timeline for US label review, has not been reported ^[1]. The pharmaphorum report on the congress changes is dated 31 August 2026 ^[1]. Details on how the recommendations were graded, and the evidence reviews behind them, were not disclosed in the available reporting ^[1].