Global experts update heart failure definition to improve prevention, diagnosis and care

A new international expert consensus document refines and updates how heart failure is identified and classified, aiming to improve prevention, diagnosis and management of heart failure worldwide. According to estimates from global health data, more than 64 million adults globally currently have heart failure. Heart failure continues to increase in prevalence, driven in part by aging populations and rising rates of conditions that contribute to cardiovascular disease, such as obesity, Type 2 diabetes and high blood pressure.

The “Second Universal Definition of Heart Failure,” developed by leading cardiovascular organizations including the American Heart Association, the American College of Cardiology, the European Society of Cardiology and the World Heart Federation, in collaboration with the Heart Failure Society of America, the Heart Failure Association of the European Society of Cardiology and the Japanese Heart Failure Society, reaffirms and updates the First Universal Definition of Heart Failure, issued in 2021.

The Second Definition details a consistent and comprehensive framework, emphasizing early detection and individualized risk reduction of heart failure, and introduces the universal classification of heart failure causes, with explicit acknowledgment of geographic variation in heart failure risk and outcomes. The consensus document simultaneously published today in the American Heart Association’s flagship peer-reviewed scientific journal Circulation; the American College of Cardiology’s flagship journal JACC; the European Society of Cardiology’s journal, the European Heart Journal; and the World Heart Federation’s journal, Global Heart.

Prof. Karen Sliwa, past president of the World Heart Federation and Director of the Cape Heart Institute at the University of Cape Town highlights the growing importance of heart failure globally. ‘It is important to note that the geographic variation of pathology and factors contributing to acute and chronic heart failure has implications for the interpretation and generalizability of clinical trial results, design and conduct of future studies, and optimal care for individuals around the world’.

The updated framework introduces several key changes that standardize terminology to align clinicians, researchers, health systems and policymakers:

Universal classification of HF causes: The document introduces a standard classification system for the causes of heart failure, helping with standardized reporting of data from trials and registries. This allows clinicians to better identify underlying conditions and guide targeted care beyond the current standard treatment for heart failure.

A shift away from rigid measurement thresholds: Rather than defining heart failure based on strict cutoff values for left ventricular ejection fraction (LVEF), the updated definition takes into account differences in LVEF by sex, age and ethnicity and offers clinically actionable categories instead: reduced, preserved and improved ejection fraction.

Greater focus on early stages of disease: The updated definition emphasizes identifying people at risk or in the early stages of heart failure (before symptoms are detected) to support prevention and earlier intervention that reduces the risk of progression to advanced heart failure.

Recognition that heart failure changes over time: The condition is now described as dynamic, with potential for improvement, remission or progression, rather than a fixed diagnosis.

Attention to social and global factors: The document highlights how access to care, social drivers of health and geography affect heart failure risk and outcomes for people depending on where they live and the social and health policies and resources available in their communities.

The full paper is available here