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

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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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Bozkurt, Biykem, Coats, Andrew J.S., Tsutsui, Hiroyuki, Abdelhamid, Ca Magdy, Adamopoulos, Stamatis, Albert, Nancy, Anker, Stefan D., Atherton, John, Böhm, Michael, Butler, Javed, Drazner, Mark H., Michael Felker, G., Filippatos, Gerasimos, Fiuzat, Mona, Fonarow, Gregg C., Gomez‐Mesa, Juan‐Esteban, Heidenreich, Paul, Imamura, Teruhiko, Jankowska, Ewa A., Januzzi, James, Khazanie, Prateeti, Kinugawa, Koichiro, Lam, Carolyn S.P., Matsue, Yuya, Metra, Marco, Ohtani, Tomohito, Francesco Piepoli, Massimo, Ponikowski, Piotr, Rosano, Giuseppe M.C., Sakata, Yasushi, Seferović, Petar, Starling, Randall C., Teerlink, John R., Vardeny, Orly, Yamamoto, Kazuhiro, Yancy, Clyde, Zhang, Jian, Zieroth, Shelley·2021·European Journal of Heart Failure

DOI 10.1002/ejhf.2115

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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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Corrigendum to: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC.
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Young K, 2018, Preclinical heart failure: evaluation of long‐term outcomes in patients with stage A and stage B heart failure in the general population, Circulation, 134, A15193

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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
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
DOI: 10.1002/ejhf.2115
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2 d)
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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