Explaining Ejection Fraction 35-40% to Your Patient
Your heart's pumping strength is moderately reduced at 35-40%, which means you have heart failure with reduced ejection fraction (HFrEF) that requires immediate treatment with multiple medications to prevent hospitalization and extend your life 1.
What This Number Means
Your ejection fraction (EF) measures how much blood your heart pumps out with each beat. Think of it like this:
- Normal heart function: 53% or higher for women, 52% or higher for men 2
- Your heart: 35-40% - pumping less than normal
- What this means: Your heart muscle is weakened and not squeezing as effectively as it should 3
Why This Matters for Your Health
An EF of 35-40% places you in the HFrEF category (heart failure with reduced ejection fraction, defined as EF ≤40%) 1. This is clinically significant because:
- You face increased risk of hospitalization and life-threatening heart rhythm problems 4
- Without treatment, approximately 75% of patients don't survive 5 years after hospitalization 3
- However, with proper treatment, we can dramatically improve these outcomes
Important Context About Your Number
Your EF can change over time - it's not fixed 5. The measurement itself has some variability (about 7% up or down) 5, which is why we focus on:
- The trajectory: Whether your EF is improving, stable, or declining 1
- Your symptoms: How you feel day-to-day matters as much as the number
- Response to treatment: Many patients see improvement with medications
Since you're at 35-40%, you're in a zone where your EF could improve to above 40% with treatment, or decline further without it 1.
What Happens Next: Your Treatment Plan
You need to start multiple heart failure medications immediately - these are not optional, as they reduce your risk of death and hospitalization 3:
Foundation medications (you'll need at least two of these):
- A beta-blocker (slows heart rate, improves pumping)
- An ACE inhibitor, ARB, or ARNI (reduces strain on heart)
- A mineralocorticoid receptor antagonist if symptoms persist
SGLT2 inhibitor (newer medication that significantly reduces death risk regardless of diabetes status) 3
Diuretics as needed to relieve fluid buildup and shortness of breath 3
Device Therapy Consideration
With an EF of 35-40%, you're at the threshold where we monitor for potential need of:
- Implantable defibrillator (ICD): Generally considered if EF remains ≤35% despite optimal medical therapy, as risk of dangerous heart rhythms increases significantly below this threshold 4
- Your risk of life-threatening arrhythmias at 36-40% is lower than those with EF ≤35%, but still elevated 4
Critical Pitfalls to Avoid
- Don't wait to start medications: Every delay increases your risk
- Don't stop medications if you feel better: Your EF may have improved because of the medications
- Don't assume one measurement tells the whole story: We'll recheck your EF after optimizing treatment to see if it improves 1
The Bottom Line
Your EF of 35-40% means your heart needs help, but we have highly effective treatments that can improve both how long you live and how well you live 3. Many patients see their EF improve with proper medication adherence, and even if the number doesn't change dramatically, the medications still provide substantial protection against hospitalization and death.