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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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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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“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”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [481]
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Self-citationDapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction
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The prognostic impact of home blood pressure measurements in patients with stage B heart failure
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The Rise of Personalized Medicine in Heart Failure Management: A Narrative Review
Palaparthi, E. C., Reddy, P. A., Padala, T., Karthika, K., Paka, R., Reddy, V. A., Ayub, S., Sri, V. K., Nandan, V. R., Patnaik, P. K., et al. (2025) · Cureus · doi:10.7759/cureus.83731 · Cited by 4
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Self-citationMedication management for heart failure with reduced ejection fraction
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Los péptidos natriuréticos en el diagnóstico de la insuficiencia cardíaca en atención primaria
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Self-citationThe Role of the Vasculature in Heart Failure
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Metadata
- 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
- ORCID
- Bozkurt, Biykem
- Coats, Andrew J.S.
- Tsutsui, Hiroyuki
- Adamopoulos, Stamatis
- Albert, Nancy
- Anker, Stefan D.
- Atherton, John
- Böhm, Michael
- Butler, Javed
- Drazner, Mark H.
- Filippatos, Gerasimos
- Fiuzat, Mona
- Fonarow, Gregg C.
- Heidenreich, Paul
- Imamura, Teruhiko
- Jankowska, Ewa A.
- Januzzi, James
- Khazanie, Prateeti
- Kinugawa, Koichiro
- Lam, Carolyn S.P.
- Matsue, Yuya
- Metra, Marco
- Ohtani, Tomohito
- Ponikowski, Piotr
- Rosano, Giuseppe M.C.
- Sakata, Yasushi
- Starling, Randall C.
- Teerlink, John R.
- Vardeny, Orly
- Yamamoto, Kazuhiro
- Yancy, Clyde
- Zhang, Jian
- Zieroth, Shelley
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- 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
- bronze
- doi.org
- 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 › Physiology (medical) › 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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