Second Universal Definition of Heart Failure Aims to Improve Prevention and Care Worldwide

A new international expert consensus document refines and updates how heart failure is identified and classified, aiming to improve prevention, diagnosis and management of heart failure worldwide. According to estimates from global health data, more than 64 million adults globally currently have heart failure. Heart failure continues to increase in prevalence, driven in part by aging populations and rising rates of conditions that contribute to cardiovascular disease, such as obesity, Type 2 diabetes and high blood pressure.

The “Second Universal Definition of Heart Failure,” developed by leading cardiovascular organizations including the American Heart Association, the American College of Cardiology, the European Society of Cardiology and the World Heart Federation, 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, reaffirms and updates the First Universal Definition of Heart Failure, issued in 2021. The Second Definition details a consistent and comprehensive framework, emphasizing early detection and individualized 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 simultaneously published today in the American Heart Association’s flagship peer-reviewed scientific journal Circulation; the American College of Cardiology’s flagship journal JACC; the European Society of Cardiology’s journal, the European Heart Journal; and the World Heart Federation’s journal, 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, M.D., co-chair of the consensus document for the American Heart Association and the American College of Cardiology, medical director of the heart failure program at Ascension St. Vincent Heart Center and medical director of the Ascension St. Vincent Cardiovascular Research Institute, both in Indianapolis. “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.”

The updated framework introduces several key changes that standardize terminology to align clinicians, researchers, health systems and policymakers: Universal classification of HF causes: The document introduces a standard classification system for the causes of heart failure, helping with standardized reporting of data from trials and registries. This 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 offers clinically actionable categories instead: reduced, preserved and improved ejection fraction.

Greater focus on early stages of disease: The updated definition emphasizes 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 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,” Walsh said. The consensus document will serve as the foundation for the upcoming American Heart Association/American College of Cardiology Heart Failure Guideline, expected to publish in late 2027.

This consensus document was prepared by the volunteer writing group on behalf of 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 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. Additional co-chairs of the consensus document include Lars Kober, M.D., D.M.Sc., representing the European Society of Cardiology, and Karen Sliwa, M.D., Ph.D., representing the World Heart Federation. All writing group members and their disclosures are listed in the manuscript.