Heart failure classification in clinical practice: time to redefine?

Numerous definitions of HF have been proposed previously. Currently, the HF definition defined in the 2016 Guideline of the European Society of Cardiology is widely accepted, which is based on left ventricular functional assessment and symptoms. Patients are divided according to left ventricular ejection fraction (LVEF) to HFwith reduced ejection fraction (HFrEF): HFwith LVEF 40%; HF with mid-range ejection fraction (HFmrEF): HF with LVEF 41% to 49%; HF with preserved ejection fraction (HFpEF): HF with LVEF ≥50%. The New York Heart Association (NYHA) class defines severity of HF symptoms during exercise or at rest. Both classifications have therapeutic and prognostic impact. A new position paper proposed an “universal definition and classification of HF,” which viewed HF 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. HF is also staged as: at-risk for HF (Stage A), pre-HF (Stage B), symptomatic HF (Stage C), and advanced HF (Stage D). Finally, HF patients are divided into the following groups according to LVEF: HFrEF: symptomatic HF with LVEF 40%; HFmrEF: symptomatic HF with LVEF 41% to 49%; HFpEF: symptomatic HF with LVEF ≥50%; and symptomatic HF with a baseline LVEF 40%, a ≥10-point increase from baseline LVEF, and a second measurement of LVEF >40%.