Universal definition of heart failure
Bibliographic record
Abstract
Abstract In early 2021, the Heart Failure Society of America, the Heart Failure Association of European Society of Cardiology, and the Japanese Heart Failure Society (JHFS) proposed a new universal definition of heart failure (UDHF). Four other associations endorsed the proposal: the Canadian Heart Failure Society, the Cardiac Society of Australia and New Zealand, the Heart Failure Association of India, and the Chinese Heart Failure Association. The reasons underlying the UDHF were many but importantly included the need to define heart failure (HF) easily and reproducibly as an essential step for standardization, so that accurate comparisons can be made across geographies, health systems, and timelines. A reliable UDHF will also aid in research, clinical practice, and quality and safety improvement activities. Unlike chronic kidney disease (CKD), HF cannot be defined by a numerical abnormality in any single parameter. HF is a clinical syndrome involving a commonly accepted composite of signs, symptoms, and investigative findings that are recognized as forming an identifiable disease state. This chapter reviews the history of HF definitions and outlines the advantages of the 2021 UDHF proposed by several international cardiology societies. It outlines how staging of HF can be aided by the UDHF and how the four-stage classification of the American College of Cardiology Foundation/American Heart Association can be adapted to the UDHF, and how this can aid our appreciation of the progression from risk factors for HF through early asymptomatic disease through to mildly and severely symptomatic disease. The chapter also reviews the many uses of left ventricular ejection fraction (LVEF) to subclassify HF and also its limitations, and describe four classes of HF according to ejection fraction (EF), HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), HF with preserved EF (HFpEF), and HF with improved EF (HFimpEF). The chapter discusses the concept and usefulness of HF disease trajectories and finally outlines future uses of the UDHF in clinical practice, registries, audit, research, advocacy, and patient education.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.007 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".