“Real-World Prognostic Performance of Different Severe and Advanced Heart Failure Definitions: Data From the Swedish Heart Failure Registry”

Authors

• Federica Guidetti
• Lars H Lund
• Lina Benson
• Camilla Hage
• Felix Lindberg
• Christian Basile
• Alessandro Villaschi
• Francesca Musella
• Davide Stolfo
• Raffaele Scorza
• Guillame Baudry
• Charlotta Ljungman
• Oscar Braun
• Valeria Valente
• Biykem Bozkurt
• Marco Metra
• Gianluigi Savarese

Language

English

Publication Date

3-18-2026

Journal

The Journal of Heart and Lung Transplantation

DOI

10.1016/j.healun.2026.03.008

PMID

41862040

Abstract

Background: A valid definition of severe heart failure (HF) is essential for earlier identification, timely referral for advanced therapies, and to optimize clinical trial design.

Objectives: To assess the prevalence, prognostic performance, and 1-year outcomes associated with different definitions of severe and advanced HF (AdvHF) in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: We included 15,153 patients with EF < 40%, HF duration >6 months, and no prior left ventricular assist device or heart transplant, from the Swedish Heart Failure Registry. Several definitions of severe/AdvHF were evaluated: a simplified Heart Failure Association (HFA) definition (NYHA III-IV, EF < 30%, ≥2 HF hospitalizations in 12 months), the GALACTIC-Severe-definition (NYHA III-IV, EF < 30%, ≥1 hospitalization in 6 months), and variations adding/removing criteria such as NT-proBNP levels and diuretic dose to the HFA-AdvHF definition. Predictive performance and 1-year outcomes were analyzed.

Results: The HFA-definition identified 6.4% of patients, with a 1-year cardiovascular death/HF hospitalization risk of 70% and all-cause mortality of 45% (AUC = 0.72). The GALACTIC-Severe definition identified 12.6% of patients with slightly lower but still substantial event rates (59% and 38%, respectively; AUC = 0.73). Definitions incorporating NT-proBNP ≥2000 pg/ml had the highest prognostic accuracy (AUC = 0.75).

Conclusions: The HFA-AdvHF definition selected a smaller, high-risk group, while the GALACTIC-Severe criteria identified a broader population, with a lower, but still high risk. NT-proBNP, HF hospitalization history, and diuretic dose might represent valuable enrichment tools for future trials.

Keywords

Advanced heart failure, Advanced therapy, Durable mechanical circulatory support, Heart failure with reduced ejection fraction, Heart transplantation, RCT design, Severe heart failure

Published Open-Access

yes

Recommended Citation

Guidetti, Federica; Lund, Lars H; Benson, Lina; et al., "“Real-World Prognostic Performance of Different Severe and Advanced Heart Failure Definitions: Data From the Swedish Heart Failure Registry”" (2026). Faculty, Staff and Students Publications. 6634.
https://digitalcommons.library.tmc.edu/baylor_docs/6634