Global Experts Update Heart Failure Definition to Boost Prevention and Care

A groundbreaking international consensus document, the heart failure definition update, has been released by leading cardiovascular organizations including the American Heart Association, American College of Cardiology, European Society of Cardiology, and World Heart Federation. This "Second Universal Definition of Heart Failure" refines how the condition is identified and classified, addressing the growing global burden—over 64 million adults affected worldwide. The update emphasizes early detection, individualized risk reduction, and introduces a universal classification of heart failure causes, acknowledging geographic variations in risk and outcomes. Key changes include a shift away from rigid ejection fraction thresholds to clinically actionable categories (reduced, preserved, improved), greater focus on early stages before symptoms appear, recognition that heart failure is dynamic with potential for improvement or remission, and attention to social and global factors like access to care and social drivers of health. The document is simultaneously published in flagship journals Circulation, JACC, European Heart Journal, and Global Heart.

The consensus was developed by a volunteer writing group co-chaired by Mary Norine Walsh, M.D. (representing AHA/ACC), Lars Kober, M.D., D.M.Sc. (ESC), and Karen Sliwa, M.D., Ph.D. (WHF). Walsh stated, "Heart failure remains a major challenge that continues to grow globally, and inconsistencies in how it is defined have limited progress." The updated framework standardizes terminology to align clinicians, researchers, health systems, and policymakers. It introduces a universal classification of heart failure causes, helping standardize data reporting from trials and registries. The definition also emphasizes identifying people at risk or in early stages to support prevention and earlier intervention, reducing progression to advanced heart failure. Additionally, it highlights how social drivers of health and geography affect outcomes, tailoring care to individual circumstances.

This consensus document will serve as the foundation for the upcoming AHA/ACC Heart Failure Guideline expected in late 2027. The update is a critical step in addressing the growing prevalence of heart failure driven by aging populations and rising rates of conditions like obesity, Type 2 diabetes, and high blood pressure. By providing a clearer, more consistent framework, the new definition aims to improve prevention, diagnosis, and management of heart failure worldwide, ultimately enhancing patient outcomes. The collaborative effort underscores the global commitment to tackling this major health challenge.