Heart Failure Gets a New Definition, Experts Say It Will Transform Care

• Global health experts have updated the definition and guidelines for heart failure.
• The experts say the new guidelines were spurred by the rising prevalence of heart failure.
• The guidelines include a standard definition of heart failure, emphasize early detection, and discuss how heart failure can be effectively managed through appropriate interventions.

Health experts in the United States and around the world have updated their guidelines for identifying and classifying heart failure.

They say their goal is to improve the prevention, diagnosis, and management of heart failure.

The update was sparked by the increase in heart failure prevalence, a condition now affecting more than 64 million adults worldwide.

The increase is driven in part by aging populations and the rising rates of conditions that contribute to cardiovascular disease, such as obesity, type 2 diabetes, and high blood pressure.

The experts say the new document “details a consistent and comprehensive framework, emphasizing early detection and individualized risk reduction of heart failure.”

In June, the “Second Universal Definition of Heart Failure” was published in the American Heart Association (AHA) journal Circulation on June 18. The new definition was also published in the American College of Cardiology (ACC) journal JACC, the European Heart Journal, and the World Heart Federation’s journal Global Heart on June 29.

The new guidelines reaffirm and update the First Universal Definition of Heart Failure, issued in April 2021.

The updated document will serve as the foundation for the upcoming AHA/ACC Heart Failure Guideline, which is expected to be published in late 2027.

“Heart failure remains a major challenge that continues to grow globally, and inconsistencies in how it is defined have limited progress in research and treatment,” Mary Norine Walsh, MD, co-chair of the consensus document for AHA and ACC, and medical director of the heart failure program at Ascension St. Vincent Heart Center and Ascension St. Vincent Cardiovascular Research Institute in Indianapolis, said in a press release.

“This updated definition provides a clearer, more consistent framework to help clinicians identify risk earlier and guide more personalized treatment approaches that can help improve patient outcomes worldwide,” Walsh continued.

New heart failure definition will guide targeted care

The new guideline introduces a standard classification system for the causes of heart failure.

The document authors say the new classification framework will help with standardized reporting of data from trials and registries.

They add it will also allow 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 the University of California Los Angeles, director of the Ahmanson-UCLA Cardiomyopathy Center, and co-director of UCLA’s Preventative Cardiology Program, explained why a consistent definition is important.

“The updated universal definition of heart failure matters because it finally brings global consistency to how we diagnose and describe heart failure,” Fonarow told Healthline.

“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,” said Fonarow, who helped write the first set of guidelines in 2021, but was not involved in the updated document.

Kevin Shah, MD, a cardiologist and the program director of Heart Failure Outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in California, agreed.

“These guidelines are important because they provide a common framework for how we define, identify, and classify heart failure,” he told Healthline. “The new definition helps align clinicians, researchers, health systems, and policymakers around the same language and approach to this condition.”

Early detection of heart failure improves outcomes

The new guidelines emphasize identifying people at risk or in the early stages of heart failure before symptoms are detected.

The document authors say this emphasis will “support prevention and earlier intervention that reduces the risk of progression to advanced heart failure.”

Fonarow listed several reasons why early detection is important. Among them:

• Heart failure is often preventable.
• Treatments for hypertension, diabetes, obesity, and chronic kidney disease can dramatically reduce risk.
• Once symptoms develop, the condition becomes harder to reverse.

“The earlier we identify risk, the more effectively we can intervene and prevent onset or progression,” Fonarow said.

“By the time many patients develop symptoms, heart damage may be well established,” added Shah.

“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,” Shah said.

How heart failure may change over time

The new guidelines have updated the classification of heart failure as “dynamic” rather than as a “fixed diagnosis.”

The authors say this highlights the potential for “improvement, remission, or progression” of heart failure.

“The new framework recognizes that heart failure is not a static condition. By focusing on stages of disease, underlying causes and disease trajectories — including improvement, remission, and recovery — we can better tailor care and advance prevention efforts,” Walsh said.

Fonarow thinks this distinction is important.

“People can improve, stabilize, or worsen over time,” he explained. “This approach reflects real‑world experience: many patients [who show improvement] still remain at risk and need ongoing care.”

“[Heart failure] is not a one-time diagnosis that remains unchanged,” added Shah. “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.”

How health disparities affect heart failure

The new guidelines also take into account the differences in heart failure based on sex, age, and ethnicity.

The document also recognizes how access to care, social drivers of health, and geography affect heart failure risk.

It notes that outcomes for heart failure can vary, depending on where people live as well as the social and health policies and resources available in their communities.

“[Heart failure] does not affect every community in the same way,” said Shah. “Risk factors, access to care, socioeconomic conditions, environmental exposures, can all contribute differently between regions of the world.”

“Heart failure does not affect all communities equally,” added Fonarow. “In the U.S., disparities in care contribute to higher hospitalization and mortality rates in underserved communities.”

What to know about cardiovascular disease

In the United States, it’s estimated that 128 million people, nearly half the adult population, have some form of cardiovascular disease.

Nearly 7 million of those people have been diagnosed with heart failure.

Heart disease is listed as the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.

More than 900,000 people in the United States die each year from cardiovascular disease.

Heart disease refers to a variety of conditions that affect the heart. They range from infections to genetic defects to blood vessel diseases.

Coronary artery disease, a blockage of the arteries that supply blood to the heart, is the most common type of heart disease.

There are a number of risk factors for heart disease. They include:

• high blood pressure
• high cholesterol
• diabetes
• obesity

There are also lifestyle choices that can raise a person’s risk of heart disease. They include:

• smoking
• excessive alcohol use
• unhealthy diet
• lack of exercise

Treatments for heart disease range from medications to lifestyle changes to surgery.

New technology is also aiding in heart disease diagnosis and treatment.

The Food and Drug Administration (FDA) recently approved the use of EchoNext, an artificial intelligence tool that reads a standard electrocardiogram and flags patients at high risk for structural heart disease.

Fonarow said there are several aspects of heart failure that people should know. Among them:

• heart failure is common
• it’s not just a “weak heart”
• it’s often preventable
• symptoms may be subtle
• early detection can save lives
• people with heart failure can improve

“The updated definition reinforces that heart failure is a condition we can detect earlier, treat more effectively, and, importantly, often prevent,” Fonarow said.