Statement outlines a structured approach to recognizing, evaluating, and managing right heart failure across the spectrum of cardiovascular disease
WASHINGTON, Oct. 27, 2026 /PRNewswire/ -- A new Scientific Statement from the Heart Failure Society of America (HFSA) calls for right heart failure (RHF) to be recognized as a distinct clinical syndrome, rather than simply a secondary complication of left-sided heart disease. Published today in the Journal of Cardiac Failure (JCF), the statement, Right Heart Failure: An HFSA Scientific Statement, synthesizes current evidence and provides a structured framework to guide earlier recognition and more consistent management of RHF in clinical practice.
RHF is common, growing more prevalent as pulmonary vascular disease advances, and carries serious consequences: longer hospitalizations, heavier ICU use, and frequent readmissions that place substantial strain on the healthcare system, according to the statement.
"Right heart failure has too often been treated as an afterthought of left heart disease," said Manreet K. Kanwar, MD, corresponding author of the statement, University of Chicago. "This statement makes the case that RHF should be recognized and managed as its own syndrome, with a diagnostic approach and treatment strategy tailored to right ventricular physiology."
The statement lays out a structured, three-pillar approach to acute RHF in the ICU, risk-assessment tools for escalating PAH therapy, and clear guidance on when, and when not, to use PAH-targeted therapies, mechanical circulatory support, or tricuspid valve interventions, across the settings where RHF most often arises: cardiogenic shock, PAH, chronic left heart failure, and after mechanical circulatory support or transplantation.
Top 10 Take-Home Messages
- Right Heart Failure (RHF) is common and prognostically important across the spectrum of heart failure and becomes increasingly prevalent as pulmonary vascular disease advances. It should be recognized as a distinct clinical syndrome rather than simply a secondary complication of left-sided heart disease.
- Progressive right ventricular (RV) dysfunction is the principal determinant of symptoms, hospitalization, and death in advanced pulmonary arterial hypertension (PAH). Serial multiparametric risk assessment—including validated tools such as REVEAL 2.0 or guideline-based risk models—should guide timely escalation of PAH therapy and referral for advanced therapies.
- RHF is an important complication after left ventricular assist device (LVAD) implantation and heart transplantation, although reported incidence varies substantially with the definition and severity threshold used. Standardized perioperative assessment and management of preload, pulmonary vascular load, contractility, and rhythm may facilitate earlier recognition and treatment.
- RHF should be evaluated using a structured, multiparametric approach integrating clinical examination, biomarkers, echocardiography, and—when diagnosis, severity, or treatment decisions require greater precision—right-heart catheterization. No single measurement adequately defines RHF.
- Management of acute RHF requires simultaneously addressing all 3 pillars: optimization of preload, reduction of RV afterload, and support of contractility and systemic perfusion. In addition, rhythm management and an RV-protective ventilatory strategy are key components of management of acute RV failure in the ICU.
- PAH-targeted therapies improve outcomes in appropriately classified PAH but should not be used routinely in pulmonary hypertension (PH) associated with left-heart disease, where trials have generally shown no benefit and, with some agents, fluid retention or harm. Accurate hemodynamic classification is therefore essential before treatment.
- Temporary mechanical circulatory support (MCS)—including percutaneous RV assist devices, surgical right ventricular assist devices (RVADs), and venoarterial extracorporeal membrane oxygenation (VA-ECMO)—may be considered in selected patients with refractory RHF and cardiogenic shock as a bridge to recovery, decision, durable support, or transplantation. Device choice should reflect the dominant physiology, oxygenation needs, and therapeutic destination.
- Transcatheter tricuspid interventions improve symptoms and quality of life in appropriately selected patients with severe tricuspid regurgitation (TR), although effects on survival remain uncertain. Surgical or transcatheter intervention should be considered before advanced RV dysfunction, severe pulmonary vascular disease, or end-organ injury makes benefit unlikely.
- RHF is associated with longer hospitalization, greater ICU use, frequent readmission, and substantial healthcare utilization. Its incremental economic burden—and the extent to which current coding and reimbursement systems capture that burden—remain incompletely characterized.
- RHF remains inadequately studied. Progress requires consensus definitions, standardized and patient-centered trial endpoints, deeply phenotyped registries, validated prediction models, and adequately funded RHF-specific clinical trials.
"Our hope is that this framework gives clinicians a structured way to recognize and manage right heart failure earlier, and gives the research community a foundation to close the gaps that have limited progress in this field," said Ryan J. Tedford, MD, senior author of the statement, Medical University of South Carolina.
By consolidating current evidence and outlining clear knowledge gaps, the HFSA Scientific Statement aims to help clinicians apply a more consistent, pathophysiology-driven approach to RHF, while laying the groundwork for the research the writing group says is needed to advance the field.
Supporting Materials
In addition to reviewing the guidance found within the statement, clinicians can use the Top Ten Take-Home Messages slide deck, designed by the statement's lead author, as a quick reference guide, available on the hfsa.org website.
View all HFSA published scientific statements, guidelines and other clinical documents.
About the Heart Failure Society of America
The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org.
About the Journal of Cardiac Failure
The Journal of Cardiac Failure (JCF) publishes the highest quality science in the field of heart failure with a focus on diversity, equity, and inclusion, mentorship, multidisciplinary partnerships, and patient-centeredness. Published papers span original investigator-initiated work to state-of-the-art reviews, guidelines and scientific statements, expert perspectives, early career and trainee spotlight pieces, patient and patient-partner narratives. JCF also emphasizes the power of language and prioritizes innovative approaches to dissemination of published work to reach and impact the broader heart failure community.
Media Contact: Laura Poko, 301-798-4493, ext. 226, lpoko@hfsa.org, hfsa.org website
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SOURCE Heart Failure Society of America
