A new international expert consensus document, the “Second Universal Definition of Heart Failure,” refines how heart failure is identified and classified, aiming to improve prevention, diagnosis, and management worldwide. Published simultaneously in leading journals including Circulation, the Journal of the American College of Cardiology, the European Heart Journal, and Global Heart, the document updates the 2021 First Universal Definition and is endorsed by major cardiovascular organizations including the American Heart Association, American College of Cardiology, European Society of Cardiology, and World Heart Federation.
Heart failure affects more than 64 million adults globally, and its prevalence is rising due to aging populations and increasing rates of obesity, Type 2 diabetes, and high blood pressure. According to the consensus document, inconsistencies in how heart failure has been defined have limited progress in research and treatment. “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,” said Mary Norine Walsh, M.D., co-chair of the consensus document for the American Heart Association and the American College of Cardiology.
Key changes in the Second Universal Definition include a universal classification of heart failure causes, which standardizes reporting across trials and registries, allowing clinicians to better identify underlying conditions and guide targeted care. The document shifts away from rigid measurement thresholds for left ventricular ejection fraction (LVEF), instead considering differences by sex, age, and ethnicity and offering clinically actionable categories: reduced, preserved, and improved ejection fraction. Greater emphasis is placed on early stages of disease, identifying people at risk or in early stages before symptoms appear, to support prevention and earlier intervention that reduces progression to advanced heart failure.
The updated framework also recognizes that heart failure is dynamic, with potential for improvement, remission, or progression, rather than a fixed diagnosis. It highlights social and global factors, noting how access to care, social drivers of health, and geography affect heart failure risk and outcomes. “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. The implications of this update are significant for clinicians, researchers, health systems, and policymakers, as it provides a consistent framework to improve data comparison, guide personalized treatment, and address disparities in heart failure care globally.
