Ambulatory Stage C2D Heart Failure Definitions and Current Therapeutic Approaches: JACC: Heart Failure Position Statement.

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.