A new international expert consensus document, the “Second Universal Definition of Heart Failure,” has been released to refine and update how heart failure is identified and classified, aiming to improve prevention, diagnosis and management globally. According to estimates from global health data, more than 64 million adults worldwide currently have heart failure, and its prevalence continues to rise, driven by aging populations and increasing rates of obesity, Type 2 diabetes, and high blood pressure.
The consensus document was developed by leading cardiovascular organizations, 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. It reaffirms and updates the First Universal Definition of Heart Failure issued in 2021, and was simultaneously published in the journals Circulation (American Heart Association), JACC (American College of Cardiology), the European Heart Journal (European Society of Cardiology), and Global Heart (World Heart Federation).
The updated framework introduces several key changes. It provides a universal classification of heart failure causes, helping clinicians identify underlying conditions and guide targeted care beyond standard treatment. It 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. The definition places greater focus on early stages of disease, emphasizing identification of people at risk or in early stages before symptoms appear, to support prevention and earlier intervention. It recognizes that heart failure is dynamic, with potential for improvement, remission or progression, rather than a fixed diagnosis. Additionally, it highlights how access to care, social drivers of health and geography affect heart failure 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 and medical director of the Ascension St. Vincent Cardiovascular Research Institute, both in Indianapolis. “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 to publish in late 2027. The implications of this update are significant: by standardizing terminology and emphasizing early detection and individualized care, the new definition aims to improve patient outcomes, facilitate research, and guide health policy worldwide. It also acknowledges geographic variation in heart failure risk and outcomes, which may lead to more tailored interventions for different populations.
