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Universal Definition and Classification of Heart Failure: A Step in the Right Direction from Failure to Function - American College of Cardiology

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Clearly defining heart failure (HF) in clinical practice and for the purposes of clinical research can be elusive and hard to standardize. Most definitions focus on diagnostic features of HF as a clinical syndrome, but there is significant heterogeneity regarding specific diagnostic criteria. In an effort to provide more specificity, some early definitions proposed the incorporation of hemodynamic and metabolic concepts.1,2 However, assessment and application of such parameters can be difficult in routine clinical practice. Further, the criteria used to define HF in clinical trials have been highly variable, posing limitations on the collection of related endpoints of interest, especially HF-related hospitalizations. As the burden of HF continues to increase and growing evidence suggests deficiencies in the implementation of guideline-directed medical therapy (GDMT),3 the need for a universal definition of HF that is clinically relevant, simple, comprehensive, globally applicable, and

Quick Takes The proposed universal definition describes HF as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. HF stages have been revised to emphasize symptomatic nature of HF as a clinical syndrome: At risk for HF (Stage A), Pre‐HF (new!) (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Classification of HF according to LVEF now includes: HFrEF: symptomatic HF with LVEF ≤40% HFmrEF: symptomatic…

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