A Heart Failure Society of America (HFSA) statement outlines ways to identify and manage right heart failure across several clinical settings, while calling for a care and research framework that treats the condition on its own terms.
HFSA announced Oct. 27 that the statement was published that day in the Journal of Cardiac Failure. It addresses right heart failure in cardiogenic shock, chronic left-heart failure and advanced pulmonary arterial hypertension (PAH), as well as cases following left-ventricular assist device (LVAD) implantation or heart transplantation.
The statement recommends combining clinical examination, biomarkers and echocardiography when assessing the condition. Right-heart catheterization can be used when clinicians need greater precision for a diagnosis or treatment decision. The statement says no single measure adequately defines right heart failure.
For acute cases in intensive care, the proposed approach addresses the amount of blood entering the right ventricle and the resistance it must pump against, while supporting the ventricle’s contraction and circulation through the body. It also includes heart-rhythm management and ventilation designed to protect the right ventricle.
In advanced PAH, the statement identifies worsening right-ventricular function as a major factor in symptoms, hospitalizations and deaths. It recommends repeated risk assessments, using tools such as REVEAL 2.0 or guideline-based models, to inform treatment escalation. It advises against routine use of PAH-targeted drugs for pulmonary hypertension associated with left-heart disease. Trials have generally found no benefit, and some drugs have been linked to fluid retention or harm.
The statement describes right heart failure as a complication after LVAD implantation and heart transplantation. Reported incidence varies with the definition used and the severity threshold applied. HFSA said the condition is associated with longer hospital stays, greater intensive-care use and frequent readmissions.
“Right heart failure has too often been treated as an afterthought of left heart disease,” said Manreet K. Kanwar, MD, the statement’s corresponding author.
The statement calls for consensus definitions, consistent measures for trials, registries and dedicated clinical trials to address gaps in the evidence.
