4 The proposed universal definition emphasizes HF is 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. In response to the necessity for a consensus definition for HF, in 2020 a writing committee comprised of members of the Heart Failure Society of America (HFSA), the Heart Failure Association of the European Society of Cardiology (HFA/ESC), and the Japanese Heart Failure Society (JHFS) across 14 countries and 6 continents assembled a consensus document resulting in the new Universal Definition and Classification of HF. As the burden of HF continues to increase and growing evidence suggests deficiencies in the implementation of guideline-directed medical therapy (GDMT), 3 the need for a universal definition of HF that is clinically relevant, simple, comprehensive, globally applicable, and allows all stakeholders to stage, prognosticate and guide available therapies, was urgently needed. Further, the criteria used to define HF in clinical trials have been highly variable, posing limitations on the collection of related endpoints of interest, especially HF-related hospitalizations. 1,2 However, assessment and application of such parameters can be difficult in routine clinical practice. In an effort to provide more specificity, some early definitions proposed the incorporation of hemodynamic and metabolic concepts. Most definitions focus on diagnostic features of HF as a clinical syndrome, but there is significant heterogeneity regarding specific diagnostic criteria.
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