A new international consensus on heart failure (HF) has issued updated guidance that includes a significant change to how the condition is classified and emphasises a more clinically driven approach to diagnosis and management.

Developed by representatives of the European Society of Cardiology, the World Heart Federation, the American Heart Association, and the American College of Cardiology, the new advice reflects the growing prevalence of the disease and the importance of early detection and individualised risk reduction.

The most significant change in the guidance is the move away from “arbitrary” left ventricular ejection fraction (EF) cut-off values for heart failure classification.

Instead, the authors recommend “clinically actionable” groups that better reflect the continuum of the disease and support more tailored management.

In place of multiple EF categories, the consensus now recommends HF with reduced EF (HFrEF), HF with preserved EF (HFpEF) and HF with improved EF (HFimpEF).

“The recognition of HF trajectories—improvement, remission, and recovery—underscores the dynamic nature of the disease and the need for ongoing surveillance and tailored therapy, even for patients who demonstrate significant improvement,” the authors said, in a paper published in the Journal of the American College of Cardiology [link here].

The guidance stresses that even patients who experience significant clinical improvement should still undergo regular surveillance and maintain guideline-directed therapy where appropriate, as improvements can be transient.

Elsewhere, the experts also emphasise that every patient should have a clearly identified cause of HF.

In clinical practice, cases are often classed as ischaemic or non-ischaemic cardiomyopathy, but this “omits the many causes of dilated and hypertrophic cardiomyopathies and does not acknowledge the impact of identifying specific causes on treatment,” according to the paper.

As such, the document proposes a universal classification of HF causes.

“Identifying specific treatable causes will guide targeted treatment selection beyond standard HF treatment approaches,” the authors note.

“A prime example is an individual with cardiac amyloidosis as the underlying cause of HF, who will benefit from targeted treatment of cardiac amyloidosis beyond conventional HF therapies,” they add.

Meanwhile, the guidance also recognises worsening HF as a key clinical event that reflects disease progression, and reinforces that HF prevention should become routine cardiology practice.

In addition, it highlights the need to recognise HF mimics and the importance of distinguishing them from true HF syndromes, reinforcing the need for “vigilance and a holistic approach to patient assessment”.