The Second Universal Definition of Heart Failure (2026). What’s new?
Design
Guideline
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's very different than heart failure with persistent low ejection fraction, and it's certainly very different from heart failure that started out with more preserved ejection fraction. This is a category of patients who on guideline-directed medical therapy—whatever that has been, either medical therapy or device therapy—have improved ejection fraction, and this is a group of patients we have to continue to monitor clinically both with imaging and also follow-up to make certain that their clinical status remains improved.”
“We've shifted away from rigid definitions of specific ejection fractions to define a specific type of heart failure. The updated definition takes into account differences in LVEF based on sex, age, and some differences with ethnicity.”
“That's been a little controversial, but we felt that the fact that the measurements had previously been so rigid really limited some of the thoughts about heart failure pathology.”
Implication
Prompts reclassification of prior HFmrEF cases in practice; extends 2021 definitions by adding HFimpEF and global factors.
Key Points
- To summarize the diagnostic and classification updates established in the 2026 Second Universal Definition of Heart Failure by an international joint task force.
- Convened a joint expert task force across AHA, ACC, ESC, and WHF in collaboration with HFSA, HFA, and JHFS.
- Revised the 2021 framework by re-evaluating left ventricular ejection fraction classifications, etiology frameworks, disease stages, and global epidemiological variations.
- Eliminated HFmrEF as a discrete category, replacing rigid cutoffs with three broad ejection-fraction categories: HFrEF, HFpEF, and HFimpEF.
- Introduced an ejection-fraction-independent universal classification for underlying causes while formalizing the clinical distinction between worsening and decompensated heart failure.
- Integrated global geographic diversity in heart failure etiology alongside the impact of social determinants on disease risk and patient outcomes.
PICO
P
Population
Heart failure
I
Intervention / Comparator
Second Universal Definition of Heart Failure (2026)
The 2026 Universal Definition of Heart Failure updates the classification system by removing HFmrEF, focusing on HFrEF, HFpEF, and HFimpEF, and incorporating global perspectives on etiology and social determinants.
Cite This Study
Biegus et al. (2026) conducted a review in Heart failure. Second Universal Definition of Heart Failure (2026) was evaluated. The 2026 Second Universal Definition of Heart Failure refines the diagnostic framework by removing HFmrEF as a separate category and proposing three broad LVEF-based categories: HFrEF, HFpEF, and HFimpEF.