Table 1.

Updated HFA-ESC criteria for defining ADHF. From M.G. Crespo-Leiro et al. Eur J Heart Fail.2018 [6], with permission.

All the following criteria must be present despite optimal guideline-directed treatment:
1. Severe and persistent symptoms of heart failure [NYHA class III (advanced) or IV].
2. Severe cardiac dysfunction defined by a reduced LVEF ≤30%, isolated RV failure (e.g., ARVC) or non-operable severe valve abnormalities or congenital abnormalities, or persistently high (or increasing) BNP or NT-proBNP values and data of severe diastolic dysfunction or LV structural abnormalities according to the ESC definition of HFpEF and HFmrEF.
3. Episodes of pulmonary or systemic congestion requiring high-dose intravenous diuretics (or diuretic combinations) or episodes of low output requiring inotropes or vasoactive drugs or malignant arrhythmias causing >1 unplannedvisit or hospitalization in the last 12 months.
4. Severe impairment of exercise capacity with Inability to exercise or low 6MWD (<300 m) or pVO2 (<12–14 mL/kg/min), estimated to be of cardiac origin.
In addition to the above, extra-cardiac organ dysfunction due to heart failure (e.g., cardiac cachexia, liver, or kidney dysfunction) or type 2 pulmonary hypertension may be present but are not required.

ARVC, arrhythmogenic right ventricular cardiomyopathy; BNP, B-type natriuretic peptide; ESC, European Society of Cardiology; HFA, Heart Failure Association; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; LV, left ventricular; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; pVO2, peak exercise oxygen consumption; RV, right ventricular; 6MWTD, 6 min walk test distance.