Global experts update heart failure definition to improve prevention, diagnosis and care
An updated international expert consensus document has refined the identification and classification of heart failure, with the goal of enhancing its prevention, diagnosis, and management globally. Global health data indicates that over 64 million adults worldwide are currently living with heart failure. The prevalence of heart failure is steadily rising, partly due to an aging global population and the increasing incidence of cardiovascular risk factors like obesity, Type 2 diabetes, and high blood pressure.
This new document, titled the “Second Universal Definition of Heart Failure,” was created by prominent cardiovascular organizations, including the American Heart Association, American College of Cardiology, European Society of Cardiology, and World Heart Federation. They collaborated with the Heart Failure Society of America, the Heart Failure Association of the European Society of Cardiology, and the Japanese Heart Failure Society to reaffirm and update the initial Universal Definition of Heart Failure, which was released in 2021.
The Second Definition outlines a comprehensive and consistent framework, highlighting the importance of early detection and personalized risk reduction for heart failure. It also introduces a universal classification system for heart failure causes, explicitly recognizing geographical differences in risk and patient outcomes. This consensus document was concurrently published in several leading journals: Circulation, the American Heart Association’s flagship peer-reviewed scientific journal; JACC, the American College of Cardiology’s flagship journal; the European Heart Journal, published by the European Society of Cardiology; and Global Heart, the journal of the World Heart Federation.
Mary Norine Walsh, M.D., co-chair of the consensus document for both the American Heart Association and the American College of Cardiology, commented, “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.” Dr. Walsh, who is also the medical director of the heart failure program at Ascension St. Vincent Heart Center and medical director of the Ascension St. Vincent Cardiovascular Research Institute in Indianapolis, added, “This updated definition provides a clearer, more consistent framework to help clinicians identify risk earlier and guide more personalized treatment approaches that can help improve patient outcomes worldwide.”
This revised framework brings forth several significant changes designed to standardize terminology for clinicians, researchers, health systems, and policymakers alike:
Universal classification of HF causes: A standardized classification system for heart failure etiologies is presented in the document. This will facilitate consistent data reporting from clinical trials and registries, enabling clinicians to more effectively pinpoint underlying conditions and direct specific treatments beyond existing standard care.
Moving beyond rigid measurement thresholds: Instead of relying on strict cutoff values for left ventricular ejection fraction (LVEF) to define heart failure, the revised definition considers variations in LVEF across different sexes, ages, and ethnicities. It now proposes clinically actionable categories: reduced, preserved, and improved ejection fraction.
Enhanced focus on early disease stages: The updated definition places increased emphasis on identifying individuals at risk for or in the nascent stages of heart failure (prior to symptom manifestation). This supports preventive measures and earlier interventions, thereby reducing the likelihood of progression to advanced heart failure.
Acknowledging heart failure’s dynamic nature: The condition is now characterized as dynamic, meaning it can show improvement, enter remission, or progress, rather than being considered a static diagnosis.
Consideration of social and global factors: The document underscores how elements such as access to healthcare, social determinants of health, and geographical location influence heart failure risk and patient outcomes. These factors vary based on where individuals reside and the health policies and resources present in their communities.
Walsh stated, “The new framework recognizes 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.”
This consensus document is intended to form the basis for the forthcoming American Heart Association/American College of Cardiology Heart Failure Guideline, which is anticipated for publication in late 2027.
A volunteer writing group prepared this consensus document for the Joint American Heart Association/American College of Cardiology/European Society of Cardiology/World Heart Federation Task Force for the Universal Definition of Heart Failure. This effort was undertaken 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. Other co-chairs for the document include Lars Køber, M.D., D.M.Sc., representing the European Society of Cardiology, and Karen Sliwa, M.D., Ph.D., representing the World Heart Federation. The complete list of writing group members and their disclosures can be found within the manuscript.
