LAUSR

This issue hosts a landmark paper with the universal definition of heart failure (HF) developed by the HF Association (HFA), the HF Society of America and the Japanese HF Society and endorsed by four other HF societies.1 HF is defined 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.’ Four stages are described: Stage A, for patients at risk for HF but without evidence of heart disease; Stage B, pre-HF, for patients without current or prior symptoms or signs of HF but with evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels; Stage C, HF, for patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality; Stage D, advanced HF, for patients with severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite guideline-directed medical therapy (GDMT), refractory or intolerant to GDMT, and requiring advanced therapies such as transplant, mechanical circulatory support, or palliative care.1 Stage D overlaps with advanced HF, as previously defined by a HFA position statement.2 A classification of HF according to left ventricular ejection fraction (EF) is also adopted with patients classified into those with reduced EF (HFrEF, EF ≤40%), mildly reduced EF (HFmrEF, EF 41-49%), preserved EF (HFpEF, EF ≥50%) and improved EF (HFimpEF, baseline EF ≤40%, a ≥10 point increase in EF and a second EF >40%).1 Attended by an outstanding editorial comments by Dr. Braunwald,3 and in line with recent consensus recommendations on definitions for the assessment of HF therapies,4 the universal definition of HF represents a fundamental framework to standardize the identification and classification of patients with HF both for daily practice and clinical studies.