What are the American Heart Association (AHA) guidelines for heart failure ejection fractions?

From the Guidelines

The American Heart Association (AHA) guidelines define Heart Failure with Reduced Ejection Fraction (HFrEF) as a Left Ventricular Ejection Fraction (LVEF) of ≤40% and Heart Failure with Preserved Ejection Fraction (HFpEF) as an LVEF of ≥50%.

Classification of Heart Failure

• HFrEF: LVEF ≤40% 1
• HFpEF: LVEF ≥50% 1
• Heart Failure with Mid-range Ejection Fraction (HFmrEF): LVEF between 41% and 49% 1

Importance of LVEF Measurement

LVEF is crucial in classifying patients with heart failure, as it affects prognosis and response to treatments 1. The guidelines emphasize the importance of evaluating the trajectory of LVEF over time, especially in patients with HFmrEF, as a single measurement may not be adequate 1.

Diagnostic Considerations

The diagnosis of HFmrEF and HFpEF can be challenging, and the guidelines recommend supporting the clinical diagnosis with objective measures, such as elevated natriuretic peptide levels or evidence of increased LV filling pressures 1.

From the Research

American Heart Association (AHA) Guidelines for Heart Failure Ejection Fractions

The American Heart Association (AHA) guidelines for heart failure ejection fractions are as follows:

• Heart failure with reduced ejection fraction (HFrEF) is defined as an ejection fraction (EF) of 40% or less 2
• Heart failure with preserved ejection fraction (HFpEF) is defined as an EF of 50% or more 2
• Heart failure with mid-range ejection fraction (HFmrEF) is defined as an EF between 41% and 49% 2, 3

Ejection Fraction Classification

The AHA classification of heart failure by ejection fraction is:

• HFrEF: EF ≤40%
• HFmrEF: EF 41-49%
• HFpEF: EF ≥50% These classifications are used to guide diagnosis, treatment, and management of heart failure 2, 3

Clinical Characteristics and Outcomes

Clinical characteristics and outcomes of heart failure with different ejection fractions have been studied:

• HFmrEF has been found to have a heterogeneous clinical characteristics, with some similarities to HFrEF and others to HFpEF 2, 3
• Mortality rates among HFmrEF patients are significant and similar to those in patients with HFrEF and HFpEF 2, 4
• Predictors of incident HFmrEF include age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction 4

Treatment and Management

Treatment and management of heart failure with different ejection fractions have been studied:

• Beta blockers, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors may be beneficial for patients with HFmrEF 2
• The use of beta blockers may be beneficial for patients with heart failure with improved ejection fraction (HFiEF) 5