An international coalition of leading cardiovascular organizations has released an updated expert consensus document, the Second Universal Definition of Heart Failure, refining the classification of the disease and revising approaches to its diagnosis, prevention, and clinical management.

According to global estimates, more than 64 million adults worldwide are living with heart failure, and the number continues to rise due to population aging and the growing prevalence of major risk factors such as obesity, type 2 diabetes, and hypertension.

The updated definition was developed jointly by the American Heart Association, American College of Cardiology, European Society of Cardiology, World Heart Federation, together with professional cardiovascular societies from the United States, Europe, and Japan. The consensus statement was published simultaneously in the journals Circulation, JACC, European Heart Journal, and Global Heart.

Universal Classification of Heart Failure Causes

For the first time, the document introduces a standardized system for classifying the underlying causes of heart failure.

The framework is designed to:

  • standardize data collection across clinical studies and patient registries;

  • improve identification of the primary cause of heart failure;

  • support more targeted, cause-specific treatment strategies rather than relying solely on generalized therapies.

Moving Beyond Fixed Ejection Fraction Thresholds

The updated definition revises the traditional classification based on left ventricular ejection fraction (LVEF).

Instead of relying on rigid numerical cutoffs, clinicians are now encouraged to consider:

  • the patient's sex;

  • age;

  • ethnic background.

Based on this approach, the document recognizes clinically meaningful categories of:

  • heart failure with reduced ejection fraction;

  • heart failure with preserved ejection fraction;

  • heart failure with improved ejection fraction.

Greater Emphasis on Early Disease Stages

The new framework places stronger emphasis on identifying:

  • individuals at high risk of developing heart failure;

  • patients in preclinical stages, before symptoms appear.

The goal is to enable earlier intervention and preventive strategies that can delay—or even prevent—the progression of the disease.

Heart Failure as a Dynamic Condition

Rather than treating heart failure as a fixed diagnosis, the updated definition recognizes it as a dynamic condition that may:

  • progress;

  • remain stable;

  • partially or completely regress, including periods of remission or clinical improvement.

The Role of Social and Geographic Factors

The consensus also highlights that both the risk of developing heart failure and patient outcomes are influenced by:

  • access to healthcare;

  • socioeconomic conditions;

  • geographic region and the strength of local healthcare systems.

According to the document's authors, the updated definition allows clinicians to better account for individual patient characteristics while improving treatment and prevention strategies. They note that this is particularly important for global healthcare, where approaches to diagnosing and managing heart failure have long varied across regions.

The revised definition is expected to serve as the foundation for future clinical guidelines from the American Heart Association and the American College of Cardiology, with publication anticipated by the end of 2027.