Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure

Biykem Bozkurt*, Andrew JS Coats, Hiroyuki Tsutsui, Magdy Abdelhamid, Stamatis Adamopoulos, Nancy Albert, Stefan D. Anker, John Atherton, Michael Böhm, Javed Butler, Mark H. Drazner, G. Michael Felker, Gerasimos Filippatos, Gregg C. Fonarow, Mona Fiuzat, Juan–Esteban E. Gomez-Mesa, Paul Heidenreich, Teruhiko Imamura, James Januzzi, Ewa A. JankowskaPrateeti Khazanie, Koichiro Kinugawa, Carolyn S.P. Lam, Yuya Matsue, Marco Metra, Tomohito Ohtani, Massimo Francesco Piepoli, Piotr Ponikowski, Giuseppe M.C. Rosano, Yasushi Sakata, Petar SeferoviĆ, Randall C. Starling, John R. Teerlink, Orly Vardeny, Kazuhiro Yamamoto, Clyde Yancy, Jian Zhang, Shelley Zieroth

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

In this document, we propose a universal definition of heart failure (HF) as the following: HF is 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. We propose revised stages of HF as follows. At-risk for HF (Stage A), for patients at risk for HF but without current or prior symptoms or signs of HF and without structural or biomarkers evidence of heart disease. Pre-HF (stage B), for patients without current or prior symptoms or signs of HF, but evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels. HF (Stage C), for patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality. Advanced HF (Stage D), for patients with severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite guideline-directed management and therapy (GDMT), refractory or intolerant to GDMT, requiring advanced therapies such as consideration for transplant, mechanical circulatory support, or palliative care. Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). The classification includes HF with reduced EF (HFrEF): HF with an LVEF of ≤40%; HF with mildly reduced EF (HFmrEF): HF with an LVEF of 41% to 49%; HF with preserved EF (HFpEF): HF with an LVEF of ≥50%; and HF with improved EF (HFimpEF): HF with a baseline LVEF of ≤40%, a ≥10-point increase from baseline LVEF, and a second measurement of LVEF of >40%.

Original languageEnglish (US)
Pages (from-to)387-413
Number of pages27
JournalJournal of Cardiac Failure
Volume27
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • Heart failure
  • definition of heart failure
  • heart failure with mid-range ejection fraction
  • heart failure with preserved ejection fraction
  • heart failure with reduced ejection fraction
  • improved ejection fraction
  • stages of heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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