Ambulatory Stage C2D Heart Failure Definitions and Current Therapeutic Approaches: JACC: Heart Failure Position Statement
Recommended Citation
Dunlay SM, Colvin M, Cowger JA, Crespo Leiro MG, Desai AS, Greene SJ, Gustafsson F, Hall S, Ilonze OJ, Lala A, Lam CSP, Page RL, Lund LH, McDonagh TA, McIlvennan CK, Pinney SP, Truby LK, Yancy CW, Bozkurt B, Stevenson LW. Ambulatory Stage C2D Heart Failure Definitions and Current Therapeutic Approaches: JACC: Heart Failure Position Statement. JACC Heart Fail. 2026;14(6):103101.
Document Type
Article
Publication Date
6-1-2026
Publication Title
JACC Heart Fail
Keywords
Humans, Disease Progression, Heart Failure, Heart Transplantation, Stroke Volume
Abstract
Symptomatic heart failure (HF) with reduced ejection fraction is traditionally drawn as 2 stages. Most stage C patients report manageable symptoms on guideline-directed medical therapy (GDMT), whereas stage D therapies are transplant or durable circulatory support, if eligible, and otherwise palliation with inotropic infusions or hospice considered for most. However, advanced HF includes not only end-stage D patients but also a large ambulatory population progressing beyond sustained response to GDMT who still seek and may find meaningful life-years ahead. This position statement was commissioned to enhance recognition of stage C2D, survey knowledge gaps for how stage C HF GDMT therapies should extend into C2D, and propose next steps. These include identification and curation of C2D cohorts and dissection of physiological phenotypes with social determinants and patient preferences as modifiers. Future focus on C2D will inform and inspire new strategies to revise trajectories beyond stage C2D and potentially throughout the HF journey.
Medical Subject Headings
Humans; Disease Progression; Heart Failure; Heart Transplantation; Stroke Volume
PubMed ID
42230068
Volume
14
Issue
6
First Page
103101
Last Page
103101
