Yes, HFrEF is essentially the same as systolic heart failure, though the terminology has evolved.
HFrEF (heart failure with reduced ejection fraction) was previously referred to as "systolic heart failure," and these terms describe the same clinical entity—heart failure with LVEF ≤40%. 1 The medical community has shifted toward using "HFrEF" because it more precisely defines the condition based on measurable ejection fraction rather than the broader term "systolic."
Why the Terminology Changed
The 2016 ESC Guidelines explicitly state that patients with HFrEF were "previously referred to as 'systolic HF'" 2. This shift occurred because:
- Both systolic AND diastolic dysfunction coexist: Most patients with reduced ejection fraction actually have both systolic and diastolic dysfunction, making "systolic HF" somewhat misleading 2
- Measurement precision: LVEF provides an objective, quantifiable threshold (≤40%) rather than a qualitative descriptor 1, 3
- Clinical trial standardization: Since the 1990s, clinical trials have selected patients based on LVEF measurements, and proven mortality-reducing therapies exist only for those with LVEF ≤40% 2, 1
Current Definitions
According to the most recent 2022 AHA/ACC/HFSA Guidelines 3:
- HFrEF: LVEF ≤40%
- HFmrEF (mildly reduced): LVEF 41-49%
- HFpEF (preserved): LVEF ≥50%
Important Clinical Caveat
While the terms are interchangeable in describing the same patient population, "HFrEF" is now the preferred terminology in clinical practice and should be used in documentation, as it:
- Aligns with current guideline recommendations 3
- Facilitates appropriate application of guideline-directed medical therapy (GDMT)
- Ensures clarity in clinical trials and research
- Avoids the misconception that only systolic function is impaired 4
The term "systolic heart failure" remains understood by clinicians but is considered outdated nomenclature.