A new international expert consensus document has updated the universal definition of heart failure, with a greater focus on earlier detection, standardized classification and individualized risk reduction.
The Second Universal Definition of Heart Failure has been developed by the American Heart Association, American College of Cardiology, European Society of Cardiology and World Heart Federation, in collaboration with the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology and Japanese Heart Failure Society. This new consensus document, published simultaneously in Circulation, JACC, the European Heart Journal and Global Heart, reaffirms and updates the first universal definition of heart failure, published in 2021.
The consensus document aims to provide a more consistent framework for identifying, classifying and monitoring heart failure across clinical care, research, health systems and policy. It emphasizes earlier detection, individualized prevention and more precise classification of the underlying causes of heart failure.¹
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Updated classification of heart failure
A key update is the move away from defining heart failure using strict left ventricular ejection fraction cut-off values. Instead, the consensus document recognizes clinically actionable categories, including heart failure with reduced ejection fraction, preserved ejection fraction and improved ejection fraction. This approach reflects differences in ejection fraction by factors such as sex, age, ethnicity and imaging modality.¹
The document also introduces a universal classification system for the causes of heart failure. These include ischemic, hypertensive, valvular, infiltrative, inflammatory, toxic, heritable, metabolic and pregnancy-related causes, among others. The aim is to support more precise diagnosis, registry reporting, clinical trial design and cause-targeted care.¹
Greater focus on early-stage disease
The updated definition places greater emphasis on identifying people at risk of heart failure or in the early stages of disease, before symptoms develop. This includes stage B, or pre-heart failure, where structural or functional cardiac abnormalities may already be present.¹
The document also describes heart failure as a dynamic condition, rather than a fixed diagnosis. It distinguishes between improvement, remission and recovery, while highlighting that continued surveillance may still be needed after clinical improvement.¹
In addition, the consensus recognizes the influence of access to care, social drivers of health and geography on heart failure risk, presentation and outcomes. Emerging diagnostic approaches, including artificial intelligence-enabled electrocardiography, are also discussed, although the document notes the importance of validation across diverse populations and healthcare settings.¹
The updated definition is expected to inform the forthcoming American Heart Association and American College of Cardiology Heart Failure Guideline, which is anticipated in late 2027.
Reference
- Walsh MN, Kober L, Sliwa K, et al. AHA/ACC/ESC/WHF expert consensus document: Second universal definition of heart failure. Circulation. 2026. doi:10.1161/CIR.0000000000001455.
Cite: Updated heart failure definition emphasizes earlier detection and more personalized care. touchCARDIO. July 9 2026.
Disclosure: This content has been developed independently by Touch Medical Media for touchCARDIO, utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) No funding was received in the publication of this article.
Editor: Nicola Cartridge, Director of Content
