Defining Heart Failure: Reflections on a Commitment

Heart failure will affect 1 in 4 people over their lifetime, according to the HF Stats 2025 Report.

It is one of the most complex and consequential diagnoses in cardiovascular medicine and it touches every member of the care team: The cardiologist making the diagnosis, the nurse coordinating longitudinal care, the pharmacist optimizing therapy, the patient navigating life with a chronic condition, and the caregiver who shows up every single day. The full, multidisciplinary reality of heart failure has always been at the heart of what the Heart Failure Society of America does.

In 2021, HFSA published the Universal Definition and Classification of Heart Failure. It was a landmark contribution: a concise, evidence-based framework that defined how the field diagnoses, stages and classifies this disease. Among its most important advances, the paper introduced a new staging structure in which Stage B now designates "pre-heart failure" capturing patients with structural or biomarker evidence of disease before symptoms emerge, a critical window for earlier intervention. It also established a new ejection fraction category for patients who show meaningful improvement over time, reflecting the reality that heart failure is not always a linear or static condition.

But what made that work meaningful was not just the science. It was who was at the table. HFSA convened clinicians, researchers, nurses, pharmacists, patients, caregivers, and trialists, to ensure that the definition served the entire heart failure community, not just one corner of it. When the Journal of Cardiac Failure published an accompanying editorial series, it reinforced that commitment. Perspective pieces from physicians, nurses, pharmacists, patients, international investigators, clinical trialists, regulators, and industry partners illustrated what HFSA has always understood: that progress in heart failure requires every voice.

As we move through 2026, that work continues to evolve. The field is growing, the science is advancing, and the Universal Definition of Heart Failure remains a living foundation for clinical practice, research and advocacy. This year HFSA is collaborating with the American College of Cardiology and the American Heart Association on an updated version of the Universal Definition of Heart Failure building on the work done in 2021.

HFSA remains deeply engaged in ensuring that, as this work progresses, the multidisciplinary perspective that has always defined our society remains front and center.
 

Kenneth B. Margulies, MD, FHFSA
HFSA President 2025-2026