The American Heart Association, the American College of Cardiology, the European Society of Cardiology and the World Heart Federation jointly released the “Second Universal Definition of Heart Failure” on June 29, updating the clinical framework used to identify and classify the condition for the first time since 2021.
The consensus document, published simultaneously in Circulation, JACC, the European Heart Journal and Global Heart, affects how clinicians, researchers and health systems worldwide diagnose and stage heart failure — a condition affecting more than 64 million adults globally.
Five key changes in the updated framework:
1. A new standard classification system for underlying causes of heart failure to align trial and registry data reporting.
2. A shift away from rigid ejection fraction cutoff values, with categories now accounting for differences by sex, age and ethnicity.
3. Greater emphasis on identifying patients at risk or in early, pre-symptomatic stages to support prevention before disease progression.
4. Recognition that heart failure is a dynamic condition — one that can improve, enter remission or worsen over time.
5. Explicit acknowledgment that geography, social drivers of health and care access shape heart failure risk and outcomes.
“This updated definition provides a clearer, more consistent framework to help clinicians identify risk earlier and guide more personalized treatment approaches,” said Mary Norine Walsh, MD, co-chair of the consensus document and medical director of the heart failure program at Indianapolis-based Ascension St. Vincent Heart Center. Dr. Walsh added that the prior lack of consistency in how heart failure was defined had limited progress in both research and treatment.
The Second Universal Definition will serve as the clinical foundation for an updated AHA/ACC Heart Failure Guideline expected in late 2027.
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