News: Experts propose new heart failure definition

In a report by the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, and Japanese Heart Failure Society published in the Journal of Cardiac Failure, the associations have proposed a new universal definition of heart failure (HF), hoping to directly impact patient outcomes.

They propose to redefine 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.”

Experts also proposed the revised stages of HF:

• At-risk for HF (Stage A): Patients at risk for HF but without current or prior symptoms or signs of heart failure and without structural or biomarkers evidence of heart disease
• Pre-HF (Stage B): Patients without current or prior symptoms of HF , but evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels
• HF (Stage C): Patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality
• Advanced HF (Stage D): 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

Finally, the associations proposed a new classification of heart failure according to left ventricular (LV) ejection fraction (EF). The proposed classification includes:

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

Editor’s note: The Journal of Cardiac Failure published article can be found here. To read more about heart failure documentation and coding, click here.