Top Things to Know: AHA/ACC/ESC/WHF Expert Consensus Document in Collaboration with HFSA, HFA and JHFS: Second Universal Definition of Heart Failure (2026)

Updated: June 29, 2026

Prepared by Drew Mills, MPH; Program Evaluation Analyst; Radhika Rajgopal Singh, PhD, FAHA, SVP, Science and Medicine American Heart Association

The 2026 Second Universal Definition of Heart Failure jointly issued by the AHA, ACC, ESC, and WHF, in collaboration with HFSA, HFA, and JHFS establishes a unified, internationally harmonized framework intended to standardize terminology and align clinicians, researchers, health systems, and policymakers.
The document reaffirms the four-stage continuum (A → D) and centers Stage B (pre-HF) as the critical window for early detection, close monitoring, and proactive individualized intervention - a strategic pivot away from a guideline focus dominated by symptomatic HF, given that the majority of the population resides in stages 0, A, or B.
HF is now grouped into three clinically actionable categories -HF with reduced EF, HF with preserved EF, and HF with improved EF – moving away from arbitrary numeric LVEF thresholds that did not adequately account for variability by sex, age, ethnicity, and imaging modality, and previously constrained trial eligibility and therapeutic generalizability.
The consensus proposes a standardized etiologic taxonomy (e.g., ischemic, hypertensive, valvular, infiltrative, infective, inflammatory, toxic, heritable, metabolic, pregnancy-related, stress-induced, high-output, congenital, and others), replacing overly broad ischemic vs. nonischemic distinction and enabling more precise registries, trial harmonization, and cause-targeted therapy (e.g., amyloidosis-directed treatment).
The Definition formalizes a trajectory-based framework distinguishing improvement (LVEF gain with persistent abnormalities), remission (normalized LVEF with stable biomarkers but ongoing vulnerability), and recovery (sustained normalization) reinforcing that HF is dynamic and requires ongoing surveillance and tailored therapy, even in improved patients.
Social determinants of health and geographic disparities are highlighted as major drivers of HF risk, presentation, and outcomes, and addressing them is essential for equitable, global care.
The document clarifies worsening HF (progressive symptomatic/biomarker/imaging deterioration in known HF) as distinct from decompensated HF (defined by the need for therapeutic escalation or rescue, not necessarily acuity or hospitalization), giving clinicians and trialists more precise endpoint definitions for an increasingly important pivotal event.
Beyond natriuretic peptides and troponins, AI-enabled ECG is highlighted as a promising tool for detecting left ventricular dysfunction and predicting incident HF, though the document reinforces the need for validation in diverse populations and resource-limited settings before clinical adoption.
Appropriate diagnostic vigilance for HF mimics - conditions such as coronary artery disease, chronic kidney disease, pregnancy, obesity, and deconditioning - and the need to distinguish them from true HF syndromes, is emphasized to ensure supporting a vigilant, holistic patient assessment.
The document positions the 2026 update as a living framework that abandons rigid numeric anchors in favor of clinically actionable, equity-aware, globally generalizable constructs with immediate implications for trial eligibility, endpoint adjudication, registry design, and biomarker strategy, which will all need recalibration against this new standard.

View the summary for AHA/ACC/ESC/WHF Expert Consensus Document in Collaboration with HFSA, HFA and JHFS: Second Universal Definition of Heart Failure (2026)

Citation

Walsh MN, Kober L, Sliwa K, Adamo M, Agarwal A, Banerjee A, Bozkurt B, Cikes M, Damasceno A, Desai AS, Felker GM, Hogan G, Kinugawa K, Kittleson M, Lam CSP, McDonagh T, Metra M, Mullens W, Ribeiro ALP, Vaughn Y, Vest A; on behalf of the Joint American Heart Association (AHA)/American College of Cardiology (ACC)/European Society of Cardiology (ESC)/World Heart Federation (WHF) Task Force for the Universal Definition of Heart Failure in collaboration with the Heart Failure Society of America (HFSA), the Heart Failure Association (HFA) of the European Society of Cardiology, and the Japanese Heart Failure Society (JHFS). AHA/ACC/ESC/WHF expert consensus document: second universal definition of heart failure (2026). Circulation. Published online June 29, 2026. doi: 10.1161/CIR.0000000000001455