Cited by 1,665Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsCardiovascular and exercise physiology

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

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Bozkurt, Biykem, Coats, Andrew J.S., Tsutsui, Hiroyuki, Abdelhamid, Ca Magdy, Adamopoulos, Stamatis, Albert, Nancy, Anker, Stefan D., Atherton, John +30 more·2021·European Journal of Heart Failure

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%.

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Crossref · 10.1002/ejhf.2115

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  • A biomarker-based risk score including high-sensitivity cardiac troponin T ≥6 ng/L, NT-proBNP ≥125 pg/mL, high-sensitivity C-reactive protein ≥3 mg/L, and LV hypertrophy by ECG demonstrated good discrimination and calibration for predicting 5- and 10-year heart failure risk among patients with diabetes, with the highest 5-year risk among those with scores ≥3.

    “In addition, a biomarker-based risk score including high-sensitivity cardiac troponin T ≥6 ng/L, NT-proBNP ≥125 pg/mL, high-sensitivity C-reactive protein ≥3 mg/L, and LV hypertrophy by ECG (with one point for each abnormal parameter) demonstrated good discrimination and calibration for predicting 5and 10-year HF risk among patients with diabetes.The highest 5-year risk of HF was noted among those”

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Authors
Bozkurt, B., Coats, A. J. S., Tsutsui, H., Abdelhamid, C. M., Adamopoulos, S., Albert, N., Anker, S. D., Atherton, J., Böhm, M., Butler, J., Drazner, M. H., Michael Felker, G., Filippatos, G., Fiuzat, M., Fonarow, G. C., Gomez‐Mesa, J., Heidenreich, P., Imamura, T., Jankowska, E. A., Januzzi, J., Khazanie, P., Kinugawa, K., Lam, C. S. P., Matsue, Y., Metra, M., Ohtani, T., Francesco Piepoli, M., Ponikowski, P., Rosano, G. M. C., Sakata, Y., Seferović, P., Starling, R. C., Teerlink, J. R., Vardeny, O., Yamamoto, K., Yancy, C., Zhang, J., & Zieroth, S.
Affiliations
  • Tottori University (JP)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
Bozkurt, Biykem
Venue
European Journal of Heart Failure
Published
2021-03
Volume
23
Issue
3
Pages
352-380
ISSN
  • 1388-9842 (ISSN-L)
  • 1879-0844
OpenAlex
W3132494856
Cited by
1,665
References
120
Citations by year
2026: 278 · 2025: 389 · 2024: 351 · 2023: 286 · 2022: 257 · 2021: 101
FWCI
166.94
Type
journal article
Language
en
Open access
Locations
  • European Journal of Heart Failure (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
heart failure, heart failure classification, heart failure staging, left ventricular ejection fraction, heart failure with reduced ejection fraction, natriuretic peptides, pulmonary congestion, systemic congestion
MeSH terms
Australia, Canada, Cardiology, China, Heart Failure, Humans, India, Japan, New Zealand, Prognosis, Stroke Volume, Writing, Ventricular Function, Left

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