Consensus Expert panel revises definition, classification and staging of cardiac failure

A universal definition of HF is of critical importance to clinicians, investigators, administrators, health care services, institutions, legislators, and payers alike. The increasing prevalence and burden of HF, an increased recognition of growing health care disparities,and deficiencies in the optimal treatment in HF with guideline-directed management and therapy (GDMT) strategies all underline the necessity for a universally recognizable definition of HF.To fill this gap, the team, a writing committee consisting of 37 individuals with domain expertise in HF, cardiomyopathy, and cardiovascular disease, took upon itself the task to provide a universal definition of HF that is clinically relevant, simple but conceptually comprehensive, with the ability to subclassify and to encompass stages within; with universal applicability globally, and with prognostic and therapeutic validity and acceptable sensitivity and specificity.

The new definition as proposed is "HF is 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."

The newly proposed HF stages are intended to enhance understanding and address the evolving role of biomarkers.

• At-risk for HF (stage A), At risk of heart failure- For patients at risk for HF but without current or prior symptoms or signs of HF and without structural or biomarkers evidence of heart disease.
• Pre-HF (stage B), Pre Heart failure- For patients without current or prior symptoms or signs of HF, but evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels.
• HF (stage C), Heart failure-For patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality.
• Advanced HF (stage D), for patients with severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite guideline-directed management and therapy (GDMT), refractory or intolerant to GDMT, requiring advanced therapies such as consideration for transplant, mechanical circulatory support, or palliative care.

"We envision the proposed universal definition and classifications to be used in a standardized fashion across scientific societies and guidelines, used by clinicians, and used in research studies."the team wrote.

The authors also propose the following four classifications of EF:

• HF with reduced EF (HFrEF): LVEF of up to 40%.
• HF with mildly reduced EF (HFmrEF): LVEF of 41-49%.
• HF with preserved EF (HFpEF)HF with an LVEF of at least 50%.
• HF with improved EF (HFimpEF): HF with a baseline LVEF of 40% or less, an increase of at least 10 points from baseline LVEF, and a second measurement of LVEF of greater than 40%.

For the full article follow the link: https://doi.org/10.1016/j.cardfail.2021.01.022

Primary source:Journal Of Cardiac Failure