A newly released international expert consensus document has refined and updated how heart failure is identified and classified, aiming to improve prevention, diagnosis and management of heart failure worldwide.
The Second Universal Definition of Heart Failure, developed by leading cardiovascular organisations including 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 of Heart Failure, issued in 2021.
According to estimates from global health data, more than 64m adults globally currently have heart failure. The condition continues to increase in prevalence, driven in part by ageing populations and rising rates of conditions that contribute to cardiovascular disease, like obesity, type 2 diabetes and high blood pressure.
The updated definition details a consistent and comprehensive framework, emphasising early detection and individualised risk reduction of heart failure, and introduces the universal classification of heart failure causes, with explicit acknowledgment of geographic variation in risk and outcomes.
The document was simultaneously published in the American Heart Association’s flagship peer-reviewed scientific journal Circulation; the American College of Cardiology’s flagship journal JACC; the European Society of Cardiology’s journal, the European Heart Journal; and the World Heart Federation’s journal, Global Heart.
The updated framework introduces several key changes that standardise terminology to align clinicians, researchers, health systems and policymakers:
• Universal classification of HF causes: The document introduces a standard classification system for the causes of heart failure, helping with standardised reporting of data from trials and registries. This allows clinicians to better identify underlying conditions and guide targeted care beyond the current standard treatment for heart failure.
• A shift from rigid measurement thresholds: Rather than defining heart failure based on strict cut-off values for left ventricular ejection fraction (LVEF), the updated definition takes into account differences in LVEF by sex, age and ethnicity and offers clinically actionable categories instead: reduced, preserved and improved ejection fraction.
• Greater focus on early stages of disease: The updated definition emphasises identifying people at risk or in the early stages of heart failure (before symptoms are detected) to support prevention and earlier intervention to reduce the risk of progression to advanced heart failure.
• Recognition that heart failure changes over time: The condition is now described as dynamic, with potential for improvement, remission or progression, rather than a fixed diagnosis.
• Attention to social and global factors: The document highlights how access to care, social drivers of health and geography affect heart failure risk and outcomes for people depending on where they live and the social and health policies and resources available in their communities.
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.
This consensus document was prepared by the volunteer writing group on behalf of the Joint American Heart Association/American College of Cardiology/European Society of Cardiology/World Heart Federation Task Force for the Universal Definition of Heart Failure 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. Additional co-chairs of the consensus document include Lars Køber, MD, DMSc, representing the European Society of Cardiology, and South African Karen Sliwa, MD, PhD, representing the World Heart Federation.
Consensus document
AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (2026)
Mary Norine Walsh, MD (United States), Lars Kober, MD, DMSc (Denmark), Karen Sliwa, MD, PhD (South Africa), et al.
Published in Circulation on 29 June 2026
Abstract
Heart failure (HF) remains a pressing health concern, with rising prevalence globally. Subjectivity and ambiguity in the definition of HF and its antecedent stages have limited research, global surveillance, and prevention programs. To address this, several cardiac societies and foundations convened to standardise the definition of HF in 2021 and designated stage B or pre-HF to identify individuals at risk of developing HF. In subsequent years, substantial progress and changes have been made in aspects of preventing HF, improving HF diagnosis and management, and recognising the importance of the affected individual’s voice. Global differences and disparities in HF are better understood, as are causes and comorbidities leading to differences in care, which are also influenced by access to care. This consensus document presents the Second Universal Definition of Heart Failure, aiming to standardise terminology and facilitate a uniform approach for clinicians, researchers, health systems, and policymakers. In this definition, the classification of HF phenotypes moves away from rigid left ventricular ejection fraction cut-offs, instead grouping HF into reduced, preserved, and improved ejection fraction categories to better reflect clinical realities. A universal classification of HF causes is also proposed. The document also addresses the dynamic trajectories of HF—improvement, remission, and recovery—and highlights the impact of social determinants and geographic variation on HF risk and outcomes.
By providing a comprehensive, standardised framework for HF definition and classification, this document seeks to improve prevention, early detection, and management of HF worldwide, ultimately enhancing patient care and advancing global cardiovascular health.
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