Why we love heart failure: an introduction to the universal definition of heart failure

“Stat rosa pristina nomine, nomina nuda tenemus” “The rose of old remains only through its name and we hold bare names.” Umberto Eco. Il nome della We both started to think about, research on, HF about 40 years ago, right with the publication first edition Braunwald's textbook in 1980. That was so clear. It time for us that found all essentials pathophysiology, diagnosis therapy heart disease clearly shown one place.3 also a definition usable everyday clinical work this fell love syndrome. A name, definition, may not be all, but it comes close. define have something defeat. As more as contemplate medicine, seems is done by names clear definitions. One most recent devastating diseases had, coronavirus 2019, soon very defined COVID-19, while still did know anything disease, could start searching PubMed or Google COVID-19 plus whatever interest everything coming out increased clarity. before having definition. already important enemy behind HF. Dr Braunwald had fight against. Then, methodology randomized controlled trials applied further The Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) enrolled patients ‘… based on criteria: history symptoms dyspnea fatigue both, together signs fluid retention no evidence primary pulmonary disease. were symptomatic at rest (NYHA functional class IV). (…) Measurements myocardial function required.’4 Better patients' characterization Veterans Administration comparing hydralazine–isosorbide dinitrate combination prazosin placebo.5 Eligibility trial ‘was cardiac dilatation chest x-ray film (..) echocardiography left ventricular radionuclide ejection fraction <45% association reduced exercise tolerance, assessed progressive maximal bicycle-ergometer test’.5 measurement (LVEF) became widely available Studies Left Ventricular Dysfunction (SOLVD) introduced criterion low LVEF, ‘of 0.35 less’ an integral component HF.6 However, 1995 task force European Society Cardiology (ESC) published guidelines which, nicely stated Braunwald, ‘went beyond symptoms’ ‘also required objective dysfunction definition’.7 figure Antman editorial outlines this: major discoveries step forward treatment went along milestones HF.2 Thus, nothing closer truth than quotation Albert Einstein Gregg Fonarow used another enlightening comment: ‘Many things you can count, don't count. Many can't really count.’8 There number measured, change our life and, hopefully, patients, too.