The Universal Definition and Classification of Heart Failure is a consensus statement released in 2021. The goal was to provide a standard definition of heart failure to decrease the variability in diagnosis and to better assess the impact of treatment.
Universal Heart Failure Definition: Heart failure is a clinical syndrome with current or prior:
- Symptoms and/or signs caused by structural and/or functional cardiac abnormality with at least one of the following:
- EF < 50%
- Abnormal cardiac chamber enlargement
- E/E’ of > 15
- E/E’ is a noninvasive measure of elevated LV filling pressures reported on an echocardiogram
- Moderate/severe ventricular hypertrophy or moderate/severe valvular obstruction or regurgitant lesion
AND at least one of the following:
- Elevated natriuretic peptide levels
- Objective evidence of cardiogenic pulmonary or systemic congestion by diagnostic modalities
- CXR
- Elevated filling pressures by echocardiography
- emodynamic measurement
- R heart catheterization
- Pulmonary artery catheter
Symptoms of Heart Failure
| Typical | Less Typical |
| Breathlessness | Nocturnal cough |
| Orthopnea | Wheezing |
| Paroxysmal nocturnal dyspnea | Bloated feeling |
| Reduce exercise tolerance | Postprandial satiety |
| Fatigue, tiredness | Loss of appetite |
| Ankle swelling | Decline in cognitive function, confusion (especially in the elderly) |
| Inability to exercise | Depression |
| Swelling of parts of the body other than ankles | Dizziness, syncope |
| Bendopnea |
Signs of Heart Failure
| More Specific | Less Specific |
| Elevated jugular venous pressure | Peripheral edema |
| Third heart sound | Pulmonary rales |
| Summation gallop with third and fourth heart sounds | Unintentional weight loss |
| Cardiomegaly, laterally displaced apical impulse | Weight loss with muscle wasting and cachexia |
| Hepatojugular reflux | Cardiac murmur |
| Cheyne Stokes respiration in advanced HF | Reduced air entry and dullness to percussion at lung bases suggestive of pleural effusion Tachycardia, irregular pulse Tachypnea Hepatomegaly/ascites Cold extremities Oliguria Narrow pulse pressure |
When diagnosing heart failure, the type of heart failure should be documented. The Universal Definition and Classification of Heart Failure recommends the following classification:
- HFrEF (HF with reduced ejection fraction)
- Symptomatic HF with LVEF ≤40%
- HFmrEF (HF with mildly reduced ejection fraction)
- Symptomatic HF with LVEF 41-49%
- Previously labeled as HF with mid-range ejection fraction
- HFpEF (HF with preserved ejection fraction)
- Symptomatic HF with LVEF ≥50%
- HFimpEF (HF with improved ejection fraction) – new classification
- Must meet ALL 3 criteria
- Baseline LVEF ≤ 40%
- ≥ 10-point increase from baseline LVEF
- A second measurement of LVEF > 40%
- Must meet ALL 3 criteria
