Universal Definition and Classification of Heart Failure

Area of Science:

• Cardiology
• Clinical Medicine

Background:

• Heart failure (HF) diagnosis and staging require clearer, universally accepted criteria.
• Existing classifications may not fully capture the spectrum of HF progression and subtypes.

Purpose of the Study:

• To propose a universal definition of heart failure.
• To introduce revised staging for heart failure (Stages A, B, C, D).
• To present a new classification of HF based on left ventricular ejection fraction (LVEF).

Main Methods:

• Defined HF based on clinical syndrome, cardiac abnormalities, natriuretic peptides, and congestion evidence.
• Established four stages: At-risk (A), Pre-HF (B), HF (C), and Advanced HF (D).
• Classified HF into HFrEF (≤40%), HFmrEF (41-49%), HFpEF (≥50%), and HFimpEF (improved EF).

Main Results:

• A universal definition of HF is proposed, integrating clinical, biomarker, and objective congestion findings.
• A four-stage system (A-D) is outlined for HF risk stratification and progression.
• New LVEF-based categories (HFrEF, HFmrEF, HFpEF, HFimpEF) are defined.

Conclusions:

• The proposed universal definition and staging provide a standardized framework for HF.
• The revised LVEF classification refines understanding and management of different HF phenotypes.
• These updates aim to enhance clinical practice and research in heart failure.