Heart failure: can it be defined?

Unlike hypertension, heart failure is not readily identified, defined and evaluated. Research and clinical management of heart failure has been handicapped by the absence of a clear definition. In other branches of medicine, e.g. renal or pulmonary failure can be clearly defined with the help of direct measures of organ function. Unfortunately such a parameter does not exist in cardiology to help us with defining cardiac function or failure. Representative definitions of heart failure hitherto proposed are reviewed. A common error in these 'definitions' is the confusion between formulating a definition and giving instructions on how to identify or diagnose heart failure. Other shortcomings are also recognised. From these it is possible to compile criteria which a definition of heart failure should possess. When formulating any definition, in order to avoid unnecessary detail, the importance of including only the essence and not the contingents is recognised. To find a new definition which complies best with these criteria is an important challenge facing cardiologists.