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: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association

Biykem Bozkurt, Andrew J.S. Coats, Hiroyuki Tsutsui, Ca Magdy Abdelhamid, Stamatis Adamopoulos, Nancy Albert, Stefan D. Anker, John Atherton, Michael Böhm, Javed Butler, Mark H. Drazner, G. Michael Felker, Gerasimos Filippatos, Mona Fiuzat, Gregg C. Fonarow, Juan Esteban Gomez-Mesa, Paul Heidenreich, Teruhiko Imamura, Ewa A. Jankowska, James JanuzziPrateeti 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

Research output: Contribution to journalArticlepeer-review

Abstract

In this document, we propose a universal definition of heart failure (HF) as 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 also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41–49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%.

Original languageEnglish (US)
Pages (from-to)352-380
Number of pages29
JournalEuropean Journal of Heart Failure
Volume23
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Cardiomyopathy
  • Definition of heart failure
  • HFmrEF
  • HFpEF
  • HFrEF
  • Heart failure
  • Stages of heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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