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Heart failure redefined with new classifications, staging


 

FROM THE JOURNAL OF CARDIAC FAILURE

The terminology and classification scheme for heart failure (HF) is changing in ways that experts hope will directly impact patient outcomes.

Dr. Biykem Bozkurt, professor of medicine, Baylor College of Medicine, Houston

Dr. Biykem Bozkurt

In a new consensus statement, a multisociety group of experts proposed a new universal definition of heart failure and made substantial revisions to the way in which the disease is staged and classified.

The authors of the statement, led by writing committee chair and immediate past president of the Heart Failure Society of America Biykem Bozkurt, MD, PhD, hope their efforts will go far to improve standardization of terminology, but more importantly will facilitate better management of the disease in ways that keep pace with current knowledge and advances in the field.

“There is a great need for reframing and standardizing the terminology across societies and different stakeholders, and importantly for patients because a lot of the terminology we were using was understood by academicians, but were not being translated in important ways to ensure patients are being appropriately treated,” said Dr. Bozkurt, of Baylor College of Medicine, Houston.

The consensus statement was a group effort led by the HFSA, the Heart Failure Association of the European Society of Cardiology, and the Japanese Heart Failure Society, with endorsements from the Canadian Heart Failure Society, the Heart Failure Association of India, the Cardiac Society of Australia and New Zealand, and the Chinese Heart Failure Association.

The article was published March 1 in the Journal of Cardiac Failure and the European Journal of Heart Failure, authored by a writing committee of 38 individuals with domain expertise in HF, cardiomyopathy, and cardiovascular disease.

“This is a very thorough and very carefully written document that I think will be helpful for clinicians because they’ve tapped into important changes in the field that have occurred over the past 10 years and that now allow us to do more for patients than we could before,” Eugene Braunwald, MD, said in an interview.

Dr. Eugene Braunwald, professor of medicine at Harvard Medical School in Boston

Dr. Eugene Braunwald

Dr. Braunwald and Elliott M. Antman, MD, both from TIMI Study Group at Brigham and Women’s Hospital and Harvard Medical School in Boston, wrote an editorial that accompanied the European Journal of Heart Failure article.

A new universal definition

“[Heart failure] 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.”

This proposed definition, said the authors, is designed to be contemporary and simple “but conceptually comprehensive, with near universal applicability, prognostic and therapeutic viability, and acceptable sensitivity and specificity.”

Both left and right HF qualifies under this definition, said the authors, but conditions that result in marked volume overload, such as chronic kidney disease, which may present with signs and symptoms of HF, do not.

“Although some of these patients may have concomitant HF, these patients have a primary abnormality that may require a specific treatment beyond that for HF,” said the consensus statement authors.

For his part, Douglas L. Mann, MD, is happy to see what he considers a more accurate and practical definition for heart failure.

Dr. Douglas L. Mann, professor of medicine, Washington University, St. Louis

Dr. Douglas L. Mann

“We’ve had some wacky definitions in heart failure that haven’t made sense for 30 years, the principal of which is the definition of heart failure that says it’s the inability of the heart to meet the metabolic demands of the body,” Dr. Mann, of Washington University, St. Louis, said in an interview.

“I think this description was developed thinking about people with end-stage heart failure, but it makes no sense in clinical practice. Does it make sense to say about someone with New York Heart Association class I heart failure that their heart can’t meet the metabolic demands of the body?” said Dr. Mann, who was not involved with the writing of the consensus statement.

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