ESC Congress 2026: Day 1 Recap—5 Headlines to Know

Day 1 of the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, delivered a heavy dose of practice-shaping news, from 2 major guideline overhauls to a phase 3 miss and 2 trial readouts with immediate clinical implications.

The ESC and European Renal Association (ERA) published their first joint guideline on cardiovascular disease and chronic kidney disease (CKD), while a separate update redefined heart failure phenotyping and staging outright. On the trial side, eplontersen fell short in transthyretin amyloid cardiomyopathy (ATTR-CM), aficamten delivered clear symptom and exercise benefits in non-obstructive hypertrophic cardiomyopathy (nHCM), and a first-of-its-kind randomized trial supported anticoagulation in patients with atrial fibrillation (AF) at intermediate stroke risk.

Check out our rundown of the top 5 headlines from day 1.

1. New ESC, ERA guideline calls for universal CKD screening in cardiovascular disease

The ESC and ERA issued their first joint guideline on CVD and CKD, recommending universal CKD screening for all patients with newly diagnosed CVD using both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR).¹

The guideline is built around the STAMP on CKD framework (Screen, Triage, Address risk, Modify CVD management, Plan health services) and recommends statin-based therapy regardless of lipid levels, an ACE inhibitor or angiotensin receptor blocker (ARB) plus a sodium-glucose cotransporter 2 (SGLT2) inhibitor for most patients, and finerenone plus semaglutide for patients with CKD, type 2 diabetes, and albuminuria.

2. 2026 ESC guidelines for heart failure redefine disease and treatment subtypes

The updated ESC heart failure guidelines eliminate heart failure with mildly reduced ejection fraction (HFmrEF), reestablishing 2 core phenotypes (heart failure with preserved ejection fraction [HFpEF] and heart failure with reduced ejection fraction [HFrEF]), and introduce 4-stage risk categories modeled on US staging. "Acute HF" is replaced with "decompensated HF" to better reflect gradual symptom onset, and guideline-directed medical therapy (GDMT) is subdivided into foundational medical therapy (FMT) and additional medical therapy (AMT) for added clarity.²

3. CARDIO-TTRansform: Eplontersen misses primary endpoint in ATTR-CM

The phase 3 CARDIO-TTRansform trial did not meet its primary efficacy endpoint, with no significant difference in the composite of cardiovascular mortality and recurrent cardiovascular events between eplontersen and placebo through 140 weeks in 1432 patients with transthyretin amyloid cardiomyopathy (ATTR-CM) (rate ratio, 0.89; 95% CI, 0.73-1.09; P = .277). A subgroup analysis suggested a benefit for eplontersen monotherapy among patients not on background stabilizer therapy at baseline, but no added benefit when stacked on top of a stabilizer.3

4. Aficamten safe, efficacious in nHCM, improves symptoms and exercise capacity

Full results from the phase 3 Aficamten in Non-Obstructive Hypertrophic Cardiomyopathy (ACACIA-HCM) trial showed aficamten significantly improved both Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (11.4 vs 8.4 with placebo; P = .02) and peak oxygen uptake (0.64 mL/kg/min vs -0.03 with placebo; P = .003) at 36 weeks in 517 patients with symptomatic nHCM. No patients discontinued treatment despite a higher incidence of left ventricular ejection fraction (LVEF) <50% in the aficamten arm (10% vs 1%), which was managed through dose adjustment.⁴

5. SINGLE-AF: Oral anticoagulants reduce risk of stroke in patients with AF

The first randomized trial in patients with AF at intermediate stroke risk found a 69% reduction in the composite of stroke, systemic embolism, major bleeding, and cardiovascular death with direct oral anticoagulant (DOAC) therapy (apixaban or rivaroxaban) versus no anticoagulation at 24 months (0.5% vs 1.5%; P = .028; HR, 0.31; 95% CI, 0.1-0.94). No difference in major bleeding was observed between arms.⁵

References

1. European Society of Cardiology. New ESC Guidelines recommend all patients with heart disease are tested for kidney disease. Published August 28, 2026.

2. Køber L, Adamo M, Ruwald A, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. 2026;ehag100. doi:10.1093/eurheartj/ehag100

3. European Society of Cardiology. Eplontersen trial did not meet its primary endpoint in transthyretin-mediated amyloid cardiomyopathy. Presented at: ESC Congress 2026, Hot Line 1; August 28, 2026; Munich, Germany.

4. Masri A. ACACIA-HCM: Aficamten for symptomatic nonobstructive hypertrophic cardiomyopathy. Presented at the European Society of Cardiology Congress 2026, Munich, Germany. August 28-31, 2026.

5. Joung B. SINGLE-AF: Anticoagulation for atrial fibrillation with intermediate stroke risk. Presented at the European Society of Cardiology Congress 2026, Munich, Germany. August 28-31, 2026.