Global Experts Release Second Universal Definition of Heart Failure, Shifting Focus to Early Detection and Disease Trajectory
Key Insights
The AHA, ACC, ESC, and WHF published the Second Universal Definition of Heart Failure (search) in June 2026, updating the 2021 framework to address inconsistencies in diagnosis and classification globally.
A new universal classification system for HF causes aims to standardize data reporting from registries and clinical trials, while moving away from rigid LVEF cutoff values toward a more nuanced approach accounting for age, sex, and ethnicity.
The definition emphasizes early intervention and recognizes HF as a dynamic disease with potential for improvement, remission, and recovery, rather than a fixed diagnosis.
Global cardiovascular societies have released a landmark consensus document that redefines heart failure (search) (HF), aiming to unify terminology and improve prevention, diagnosis, and treatment worldwide. The "Second Universal Definition of Heart Failure," published on June 29, 2026 in the journals Circulation, JACC, the European Heart Journal, and Global Heart, represents a collaboration among the American College of Cardiology (search) (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and World Heart Federation (search) (WHF), in partnership with the Heart Failure Society of America (HFSA), the ESC Heart Failure Association (HFA), and the Japanese Heart Failure Society (JHFS).
The update was driven by the rising global prevalence of heart failure (search), a condition now affecting more than 64 million adults worldwide, fueled by aging populations and increasing rates of obesity, type 2 diabetes, and hypertension.
"Heart failure (search) remains a major challenge that continues to grow globally, and inconsistencies in how it is defined have limited progress in research and treatment," said Mary Norine Walsh, MD, MACC, co-chair of the consensus document and medical director of the heart failure program at Ascension St. Vincent Heart Center in Indianapolis. "The new framework introduces a universal classification of causes of HF with a focus on earlier identification of risk in order to facilitate prevention."
A Universal Classification System for HF Causes
Among the most significant changes is the introduction of a standardized classification system for the causes of heart failure (search). The authors note that this framework will support standardized reporting of data from clinical trials and registries, while enabling clinicians to "better identify underlying conditions and guide targeted care beyond the current standard treatment for heart failure."
Gregg Fonarow, MD, interim chief of the Division of Cardiology at UCLA and director of the Ahmanson-UCLA Cardiomyopathy Center, who contributed to the 2021 guidelines but was not involved in the updated document, underscored the importance of consistency. "The updated universal definition of heart failure (search) matters because it finally brings global consistency to how we diagnose and describe heart failure," Fonarow said. "By modernizing the definition, clinicians can improve early detection, tailor treatment more precisely, and ultimately improve outcomes for millions of people worldwide at risk and with heart failure."
Moving Beyond Rigid LVEF Thresholds
The updated definition marks a transition away from strict cutoff values for left ventricular ejection fraction (LVEF), which the authors note can obscure potential benefits of therapies for HF phenotypes that fall outside rigid numerical boundaries. Instead, the new framework incorporates factors such as age, sex, and ethnicity, grouping HF into reduced, preserved, and improved ejection fraction categories to better "reflect clinical realities."
Kevin Shah, MD, a cardiologist and program director of Heart Failure (search) Outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center, emphasized the practical value of the new approach. "These guidelines are important because they provide a common framework for how we define, identify, and classify heart failure," Shah said. "The new definition helps align clinicians, researchers, health systems, and policymakers around the same language and approach to this condition."
Heart Failure (search) as a Dynamic Disease
A central theme of the new definition is the recognition that heart failure (search) is not a static or fixed diagnosis. The document highlights the potential for improvement, remission, and recovery, reflecting what the authors describe as a dynamic disease trajectory.
"People can improve, stabilize, or worsen over time," Fonarow explained. "This approach reflects real-world experience: many patients who show improvement still remain at risk and need ongoing care."
Shah echoed this perspective: "With modern therapies, patients experience significant improvement in heart function and symptoms, while others may worsen over time. Recognizing this as a dynamic condition can help clinicians continually reassess risk, modify treatments, and personalize care."
Emphasis on Early Intervention and Prevention
The consensus document places greater emphasis on identifying individuals at risk or in early stages of heart failure (search) before symptoms manifest. The authors state this focus will "support prevention and earlier intervention that reduces the risk of progression to advanced heart failure."
"By the time many patients develop symptoms, heart damage may be well established," Shah noted. "The new definition places a greater emphasis on identifying people who are at risk before symptoms occur. This can help us address risk factors such as hypertension, diabetes, obesity, coronary artery disease before they lead to irreversible or progressive cardiac dysfunction."
Fonarow added that heart failure (search) is often preventable, and treatments for hypertension, diabetes, obesity, and chronic kidney disease can dramatically reduce risk. "The earlier we identify risk, the more effectively we can intervene and prevent onset or progression," he said.
Addressing Disparities in Care
The document also acknowledges how access to care, geographic settings, health policies, and social drivers of health can impact HF risk and patient outcomes. "Heart failure (search) does not affect all communities equally," Fonarow said. "In the U.S., disparities in care contribute to higher hospitalization and mortality rates in underserved communities."
Shah reinforced this point: "Risk factors, access to care, socioeconomic conditions, environmental exposures, can all contribute differently between regions of the world."
Foundation for Future Guidelines
According to the ACC and AHA, the new definition will serve as the foundation for the upcoming AHA/ACC Heart Failure (search) Guideline, expected to publish in late 2027. The updated framework reaffirms and builds upon the First Universal Definition of Heart Failure released in April 2021, incorporating advances in disease manifestations, diagnostic strategies, and understanding of pathophysiology that have emerged in the intervening years.
"The updated definition reinforces that heart failure (search) is a condition we can detect earlier, treat more effectively, and, importantly, often prevent," Fonarow concluded.