The American Heart Association (AHA), American College of Cardiology (ACC), and European Society of Cardiology (ESC) recently released a statement regarding defining heart failure that aims to standardize terminology and unify the handling of heart failure by health systems, policymakers, and others. The Second Universal Definition of Heart Failure groups heart failure into three categories (reduced, preserved, and improved ejection fraction) and proposes a universal classification of causes of heart failure.
Today, we are featuring a few key highlights from the Second Universal Definition of Heart Failure. View the full-text version for the complete statement along with the most thorough explanation of the following updates.
AHA/ACC/ESC Second Universal Definition of Heart Failure Key Highlights
The 2026 statement reaffirms the first Universal Definition and Classification of Heart Failure staging (A: At risk; B: Pre-Heart Failure; C: Heart Failure; D: Advanced Heart Failure). Additionally, it’s noted that having no risk factors is denoted as Stage 0.
The new statement encourages the use of clinically actionable groups for the classification of heart failure, stepping back from using LVEF cutoffs. These groups include heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, and heart failure with improved ejection fraction (i.e, heart failure with previously reduced LVEF that has increased/normalized).
The Second Universal Definition of Heart Failure provides universal classifications of heart failure by cause. View the full-text version for a complete rundown of these classifications, but some examples include: infective cardiomyopathy: viral myocarditis, Chagas disease, HIV, lyme disease; inflammatory cardiomyopathy: autoimmune disease, sarcoidosis, hypersensitivity, desmoplakin; and ischemic cardiomyopathy: ischemic heart disease, myocardial infarction, coronary artery disease. The proposed classification by cause is meant to help standardize the reporting of heart failure causes in clinical and research settings.
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