More than 64 million adults globally currently have heart failure, a number that continues to rise due to aging populations and increasing rates of obesity, Type 2 diabetes, and high blood pressure. In response, leading cardiovascular organizations have released the “Second Universal Definition of Heart Failure,” an updated framework designed to improve prevention, diagnosis, and management of the condition worldwide. The consensus document, developed by 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 issued in 2021.
The updated definition introduces several key changes. It establishes a universal classification system for the causes of heart failure, enabling standardized data reporting from trials and registries and helping clinicians identify underlying conditions to guide targeted care. Instead of relying on rigid cutoff values for left ventricular ejection fraction (LVEF), the new framework accounts for differences by sex, age, and ethnicity and offers clinically actionable categories: reduced, preserved, and improved ejection fraction. The document also places greater emphasis on early stages of the disease, encouraging identification of individuals at risk or in pre-symptomatic phases to support prevention and early intervention. Additionally, heart failure is now described as a dynamic condition that can improve, remit, or progress, rather than a fixed diagnosis. Social and global factors, including access to care, social determinants of health, and geographic variation, are explicitly acknowledged as affecting risk and outcomes.
“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. “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 consensus document will serve as the foundation for the upcoming American Heart Association/American College of Cardiology Heart Failure Guideline, expected in late 2027. The document is simultaneously published in the American Heart Association’s flagship journal Circulation, the American College of Cardiology’s journal JACC, the European Society of Cardiology’s European Heart Journal, and the World Heart Federation’s Global Heart.
