Heart Failure Gets a New Definition (2026)

Heart failure got a new global definition this week. That may sound academic, but the practical message is simple: clinicians are being pushed to find risk earlier, name the cause more precisely, and keep managing heart failure even when a person’s numbers improve. The same theme showed up in diabetes and liver disease news: earlier diagnosis, safer choices, and better questions for the next visit.

If this describes you	This week’s most useful update	What to ask next
You live with heart failure or have diabetes, high blood pressure, or obesity	AHA, ACC, ESC, and WHF released the Second Universal Definition of Heart Failure on June 29, with a stronger focus on early-stage disease and changing disease trajectories. 1	"Am I at risk for early heart failure, and have we checked the cause?"
You have type 2 diabetes and are curious about intermittent fasting	A Lancet Diabetes & Endocrinology Personal View reviewed more than 225 trials and argued that intermittent fasting should be included as one evidence-based option for type 2 diabetes care. 2	"Can I try this safely with my current medicines?"
You have cirrhosis or MASLD, often called fatty liver disease	New blood-test studies point to earlier liver risk detection, but both come with important limits. 3 4	"Which liver risk tests are appropriate for me now?"

Cardiovascular updates

Heart failure now has a broader, earlier framework

On June 29, the American Heart Association, American College of Cardiology, European Society of Cardiology, and World Heart Federation released the Second Universal Definition of Heart Failure with HFSA, HFA, and JHFS; the document was published simultaneously in Circulation, JACC, European Heart Journal, and Global Heart. 1

The definition matters because more than 64 million adults worldwide live with heart failure, and the condition is rising alongside aging, obesity, type 2 diabetes, and high blood pressure. 1 The new framework sorts heart failure by cause, including ischemic, hypertensive, valvular, infiltrative, inflammatory, toxic, genetic, metabolic, pregnancy-related, stress-induced, high-output, and congenital categories. 5

The document also moves away from rigid left ventricular ejection fraction cutoffs and toward categories patients may hear in clinic: reduced, preserved, and improved ejection fraction. 5 Ejection fraction is the percentage of blood the left ventricle pumps out with each beat; the new definition asks clinicians to interpret that number alongside age, sex, race, imaging method, symptoms, and disease course. 5

For patients, the biggest shift may be Stage B, also called pre-heart failure. The new definition treats Stage B as a window for early detection, close monitoring, and individualized prevention before symptoms become advanced. 5 It also describes heart failure as a dynamic condition that can improve, go into remission, or recover, while still needing follow-up because vulnerability can remain. 5

Ask your clinician: "Do I have any signs of Stage B heart failure, and is my heart failure type based on the cause, not only my ejection fraction?"

Pregnancy and the year after delivery need closer heart-failure attention

An AHA scientific statement published June 24 warned that heart failure during pregnancy and after delivery is often missed because shortness of breath, fatigue, and leg swelling can look like normal pregnancy symptoms. 6 The statement said nearly one-quarter of U.S. women ages 20 to 44 have some type of cardiovascular disease, and heart disease is one of the leading causes of pregnancy-related death in the United States. 6

The risk is not limited to delivery day. The AHA statement said the first year after childbirth is a high-risk period for heart failure, with some people developing symptoms days after delivery and others weeks or months later. 6 It also reported that pregnant women with heart failure are about 32 times more likely to die around delivery than pregnant women without heart failure. 6

The statement also described major disparities: Black adults have about a 19% higher heart failure risk than white adults, Black women and American Indian women are diagnosed with peripartum cardiomyopathy more often than white women, and Black women are more likely to have delayed diagnosis. 6

Ask your clinician: "Which symptoms after delivery should make me call immediately rather than wait for the next visit?"

Rural blood pressure care needs more support, not more blame

A June 25 AHA scientific statement in Hypertension said rural Americans have higher high-blood-pressure prevalence and lower blood-pressure control than urban Americans, contributing to higher cardiovascular disease and death rates. 7 The statement pointed to clinician shortages, longer travel distances, transportation challenges, hospital closures, pharmacy deserts, higher out-of-pocket costs, and limited local resources. 7

The most practical patient-facing point is home blood pressure measurement. The statement said self-measured blood pressure monitoring is associated with better blood pressure control, especially when paired with clinical support or team-based care. 7 Remote care can help, but the statement noted that broadband access, device access, and digital literacy can limit the benefit in rural communities. 7

Ask your clinician: "Can we set up a home blood-pressure plan with clear numbers for when I should call?"

Statins may still help after age 75 in type 2 diabetes

A PLOS Medicine target-trial emulation study published June 24 examined statins for primary prevention in older adults with type 2 diabetes. 8 In adults ages 75 to 84 with type 2 diabetes, statin use was associated with 31% lower cardiovascular disease risk and 35% lower all-cause mortality; adults age 85 and older showed consistent benefit. 8 The study did not observe a significant increase in muscle-related adverse events or liver dysfunction in either age group. 8

This does not mean every older adult should start or continue a statin. It does mean that age alone is a weak reason to stop the conversation, especially for people with type 2 diabetes.

Ask your clinician: "Given my age, diabetes history, and side-effect risk, should a statin still be part of my prevention plan?"

Diabetes and weight-care updates

Intermittent fasting gets a stronger evidence review for type 2 diabetes

A June 26 Lancet Diabetes & Endocrinology Personal View reviewed more than 225 clinical trials, including nearly 40 trials in diabetes or prediabetes, and argued that intermittent fasting should be included in clinical practice guidelines as one evidence-based lifestyle option for type 2 diabetes. 2 The review said time-restricted eating, the 5:2 diet, and fasting-mimicking diets can lower HbA1c by 0.3 to 1.2 percentage points in adults with type 2 diabetes while also lowering fasting glucose, 24-hour glucose, and weight. 2

HbA1c is the blood test that estimates average blood sugar over roughly three months. A 0.3 to 1.2 percentage-point change can matter, but the right target depends on age, medication, hypoglycemia risk, kidney disease, heart disease, and personal goals.

The safety detail is the part patients should not skip. The authors wrote that intermittent fasting was as effective as calorie restriction for glycemic control and "does not increase the risk of hypoglycaemia when medications are adjusted using simple rules." 2 That medication caveat is essential for anyone using insulin or sulfonylureas, because both can cause low blood sugar if food timing changes.

The same review said evidence is insufficient for type 1 diabetes and gestational diabetes, so those groups should not treat intermittent fasting as a proven option. 2

Ask your clinician: "If I want to try time-restricted eating, which of my medications would need adjustment and what low-blood-sugar plan should I follow?"

Obesity diagnosis may become less BMI-only

On June 29, the ADA’s Obesity Association released a new Standards of Care chapter on adult obesity screening, diagnosis, evaluation, and staging. 9 One major change is that adults with a body mass index in the overweight range, 25 to 29.9, can be formally diagnosed with obesity when waist measurement shows central obesity. 9

That change matters because abdominal fat can raise cardiometabolic risk even when BMI does not cross 30. The new chapter also recommends the Edmonton Obesity Staging System for risk staging and calls for person-centered, non-stigmatizing care, including screening for past experiences of weight bias or stigma. 9

Victoria Bouhairie, MD, the ADA’s senior vice president for obesity and prevention, said, "Obesity is not simply a matter of weight—it is a multifactorial, chronic disease requiring systematic, person-centered care." 9

Ask your clinician: "Should we measure waist circumference and stage my obesity-related health risk, rather than relying only on BMI?"

Medicare GLP-1 Bridge could lower monthly cost for some patients without diabetes

Eli Lilly announced on June 25 that its Medicare GLP-1 Bridge program will start July 1, allowing eligible Medicare Part D patients to get Foundayo, orforglipron, or Zepbound, tirzepatide, for weight management at $50 per month. 10 Lilly said the program will run through December 31, 2027. 10

The eligibility details are narrow. Lilly said patients must have Medicare Part D coverage, be age 18 or older, have BMI of at least 35 or BMI of at least 27 with certain weight-related conditions, have no type 2 diabetes, and receive prior authorization. 10 Lilly estimated that about 20 million Medicare patients may meet clinical criteria for obesity medicines. 10

Ask your clinician or pharmacist: "Do I meet the clinical criteria, and what prior authorization documents would my plan require?"

Rhode Island Medicaid is moving the other direction

The American Diabetes Association said Rhode Island’s fiscal year 2027 budget will end Medicaid coverage for GLP-1 medicines used only for obesity or weight management starting October 1, 2026, while keeping GLP-1 coverage for people with type 2 diabetes. 11 The ADA said about 31% of Rhode Island adults live with obesity and that obesity costs the state economy about $1.7 billion each year. 11

For Rhode Island Medicaid members, the practical issue is timing. If a GLP-1 medicine is being used for weight management without type 2 diabetes, coverage may change in the fall.

Ask your clinician or plan: "Will my coverage change on October 1, and what alternatives should we discuss if it does?"

Liver updates

MVX may help study liver risk, but it is not a FIB-4 replacement yet

A Nature Communications study published June 23 evaluated the metabolic vulnerability index, or MVX, in 1,613 adults with biopsy-proven MASLD from the NASH Clinical Research Network. 3 MASLD stands for metabolic dysfunction-associated steatotic liver disease, the newer name for fatty liver disease linked to metabolic risk factors.

In the study, each 10-point increase in MVX was associated with higher all-cause mortality, liver-related mortality, liver decompensation, MELD score rising to at least 15, and kidney function decline. 3 MELD is a score clinicians use to estimate severity of advanced liver disease and transplant priority.

The caveat is just as important as the signal. The authors wrote that MVX was not superior to FIB-4 overall and was "unlikely to replace FIB-4 as a starting point for risk stratification" in MASLD. 3 FIB-4 is a common first-line score calculated from age, AST, ALT, and platelet count.

The study population was 85% white, and the authors said validation in more diverse populations is needed. 3

Ask your clinician: "Have we calculated my FIB-4 recently, and do I need any additional liver-risk testing?"

A blood test found more early liver cancers than ultrasound in a cirrhosis trial

The CLiMB trial enrolled 1,556 adults with cirrhosis across 42 U.S. clinical sites, and 1,268 were included in the final analysis. 4 HelioLiver Dx detected 48% of hepatocellular carcinoma cases, compared with 28% for ultrasound, while specificity was 88% for the blood test and 94% for ultrasound. 4

For tumors 2 centimeters or smaller, HelioLiver Dx detected 29% and ultrasound detected none in the trial. 4 The blood test combines cell-free DNA methylation markers with age, sex, AFP, AFP-L3, and des-gamma-carboxy prothrombin, also called DCP. 4

There are limits. HelioLiver Dx is commercially available but not FDA cleared, the trial was funded by Helio Genomics, and several authors are current or former employees. 4

Ask your liver clinician: "Is ultrasound enough for my liver cancer surveillance, or should we discuss AFP or newer blood-based tests?"

Heavy episodic drinking may raise fibrosis risk in MASLD

A June 23 report on a national NHANES analysis said 15.9% of people with MASLD reported episodic heavy drinking, defined as at least 4 drinks for women or at least 5 drinks for men on any day at least once per month. 12 Among people with MASLD, episodic heavy drinking was associated with higher odds of significant fibrosis and advanced fibrosis. 12

A separate June report said roughly 9% of U.S. adults reported both heavy drinking and BMI of 30 or higher in 2023 NHANES data. 13 Newsweek also reported that MetALD, which refers to metabolic dysfunction and alcohol-associated liver disease, has more than doubled since 1990. 13

The patient takeaway is not moral judgment. It is risk math. If a person has fatty liver, obesity, diabetes, high blood pressure, or abnormal cholesterol, alcohol may carry more liver risk than the same amount would in someone without those metabolic factors.

Ask your clinician: "Given my liver and metabolic risk, what alcohol limit is safest for me?"

Bepirovirsen has an October FDA decision date for chronic hepatitis B

AJMC reported June 29 that the FDA accepted GSK’s bepirovirsen application for Priority Review, with Breakthrough Therapy and Fast Track designations and a target decision date of October 26, 2026. 14 In the B-Well 1 and B-Well 2 phase 3 trials, a 24-week course of 300 mg weekly subcutaneous bepirovirsen achieved functional cure in about 20% and 19% of patients, compared with 0% with placebo. 14 Functional cure meant HBV DNA below the lower limit of quantification and undetectable hepatitis B surface antigen at least 24 weeks after treatment stopped. 14

The reported safety profile included injection-site reactions in 53% of patients, mostly mild, grade 3 or higher adverse events in 16%, and transient ALT flares in 6%; AJMC reported that no drug-induced liver injury criteria were met. 14

Ask your liver clinician: "If I have chronic hepatitis B, would a finite-treatment option like this apply to me if it is approved?"

Questions to bring to your next visit

Your situation	A reasonable question this week
Heart failure, diabetes, obesity, or high blood pressure	"Do I have early heart-failure risk signs, and should my care plan change under the new definition?"
Pregnancy or within one year after delivery	"Which symptoms could signal heart failure rather than normal pregnancy or postpartum recovery?"
Rural area or limited clinic access	"Can we use home blood pressure readings as part of my treatment plan?"
Type 2 diabetes and age 75 or older	"Should I start, continue, or stop a statin based on my personal risk?"
Type 2 diabetes and interest in fasting	"What medication changes would keep fasting safe for me?"
Overweight range BMI with abdominal weight gain	"Should waist circumference and obesity staging be part of my evaluation?"
Medicare Part D and weight-management medication interest	"Could I qualify for the GLP-1 Bridge program, and what paperwork is needed?"
MASLD or cirrhosis	"Which liver screening or risk tools should we use now, and how often should we repeat them?"
Fatty liver plus alcohol use	"What alcohol limit fits my liver risk rather than a general-population guideline?"

Coverage window: June 22-29, 2026. This article is for appointment preparation and caregiver discussion, not a substitute for personal medical advice.

Cover image: image from American Heart Association Newsroom.

Heart Failure Gets a New Definition