A new international expert consensus document has been published, seeking to refine and updates how heart failure is identified and classified.
The “Second Universal Definition of Heart Failure,” has been developed by the American Heart Association (AHA), the American College of Cardiology (ACC), the European Society of Cardiology (ESC) and the World Heart Federation (WHF), in collaboration with the Heart Failure Society of America (HFSA), the Heart Failure Association of the European Society of Cardiology (HFA) and the Japanese Heart Failure Society (JHFS), reaffirms and updates the First Universal Definition of Heart Failure, issued in 2021.
The 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 is simultaneously published today in Circulation, 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 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, including introducing a standard classification system for the causes of heart failure, intended to allow clinicians to better identify underlying conditions and guide targeted care beyond the current standard treatment for heart failure.
Rather than defining heart failure based on strict cutoff values for left ventricular ejection fraction (LVEF), the updated definition also takes into account differences in LVEF by sex, age and ethnicity and offers clinically actionable categories instead: reduced, preserved and improved ejection fraction.
There is a greater focus on early stages of disease, with an updated definition emphasising identification of 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.
Furthermore, the condition is now described as dynamic, with potential for improvement, remission or progression, rather than a fixed diagnosis.
And, 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. 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,” Walsh said.
The consensus document will serve as the foundation for the upcoming AHA/ACC Heart Failure Guideline, expected to publish in late 2027.
