From the Guidelines
Treatment for Heart Failure with mid-range Ejection Fraction (HFmEF) should be guided by the same principles as Heart Failure with preserved Ejection Fraction (HFpEF) and Heart Failure with reduced Ejection Fraction (HFrEF), with a focus on optimizing Guideline-Directed Medical Therapy (GDMT).
Key Components of Treatment
- Optimization of GDMT: This includes the use of medications such as Angiotensin-Converting Enzyme Inhibitors (ACEi), Angiotensin Receptor Blockers (ARB), Angiotensin Receptor-Neprilysin Inhibitors (ARNi), Beta Blockers, Mineralocorticoid Receptor Antagonists (MRA), and Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i), as tolerated and based on patient-specific factors 1.
- Management of Comorbidities: Addressing conditions such as hypertension, diabetes, and coronary artery disease is crucial in the management of HFmEF.
- Symptom Management: Diuretics may be used as needed to manage congestion and symptoms.
Considerations for Treatment
- Patient-Specific Factors: Treatment should be tailored to the individual patient, taking into account factors such as symptoms, labs, health status, and Left Ventricular Ejection Fraction (LVEF) 1.
- Serial Reassessment: Regular reassessment of symptoms, labs, health status, and LVEF is necessary to optimize treatment and address any changes in the patient's condition.
- Investigational Therapies: Participation in investigational studies may be considered for patients with HFmEF, particularly those with advanced disease or refractory symptoms 1.
From the Research
Treatment Options for Heart Failure with Mid-Range Ejection Fraction (HFmEF)
- The treatment for HFmEF is not well established, but current evidence suggests that patients with HFmEF may benefit from medications that target the neurohormonal axes, similar to those used in patients with heart failure with reduced ejection fraction (HFrEF) 2.
- The use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is considered reasonable in patients with HFmEF 2.
- Assessment of left ventricular systolic function with contemporary noninvasive modalities, such as echocardiographic strain imaging, may be useful in selecting patients with HFmEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies 2.
- Aggressive management of comorbidities is also recommended as part of the treatment plan for patients with HFmEF 3.
- Some studies suggest that HFmEF patients may benefit from therapies that are effective in HFrEF patients, but further research is needed to confirm this 4, 5.
Clinical Characteristics and Prognosis
- Patients with HFmEF have a clinical profile and prognosis that are closer to those of patients with HFpEF than those of HFrEF, but with certain distinctions 3.
- HFmEF is considered an intermediate clinical entity between HFrEF and HFpEF in some respects, but more similar to HFrEF in others, particularly with regard to the high prevalence of ischemic heart disease in these patients 5.
- The risk of cardiovascular events is lower in patients with HFmEF or HFpEF than in those with HFrEF, but the risk of non-cardiovascular adverse events is similar or greater in patients with HFmEF or HFpEF than in those with HFrEF 5.