A new international expert consensus document has attempted to refine how heart failure is identified and classified, aiming to improve prevention, diagnosis and management of the condition worldwide.
The ‘Second Universal Definition of Heart Failure’—developed by leading cardiovascular organisations including the American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC) and World Heart Federation (WHF), in collaboration with the Heart Failure Society of America, Heart Failure Association of the ESC and the Japanese Heart Failure Society—reaffirms and updates the ‘First Universal Definition of Heart Failure’, issued in 2021.
This second definition details a consistent and comprehensive framework, emphasising early detection and individualised 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 has been simultaneously published in Circulation, the Journal of the American College of Cardiology (JACC), the European Heart Journal, and Global Heart.
“Heart failure remains a major challenge that continues to grow globally, and inconsistencies in how it is defined have limited progress in research and treatment,” said Mary Norine Walsh (Ascension St Vincent Heart Center, Indianapolis, USA), co-chair of the consensus document for the AHA and the ACC. “This updated definition provides a clearer, more consistent framework to help clinicians identify risk earlier and guide more personalised treatment approaches that can help improve patient outcomes worldwide.”
The updated framework introduces several key changes that standardise terminology to align clinicians, researchers, health systems and policymakers:
- Universal classification of heart failure causes; the document introduces a standard classification system for the causes of heart failure, helping with standardised reporting of data from trials and registries, which 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 instead offers clinically actionable categories—reduced, preserved and improved ejection fraction
- Greater focus on early stages of disease; the updated definition emphasises 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 new framework recognises that heart failure is not a static condition,” Walsh added. “By focusing on stages of disease, underlying causes and disease trajectories—including improvement, remission and recovery—we can better tailor care and advance prevention efforts.”
The consensus document will serve as the foundation for the upcoming AHA/ACC Heart Failure Guideline, which is expected to be published in late 2027.
