Is improved left ventricular ejection fraction (LVEF) used to refer to patients who previously had heart failure with reduced ejection fraction (HFrEF) and now have an LVEF >40%?

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Last updated: February 14, 2026 • View editorial policy

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The statement is TRUE: Improved LVEF (HFimpEF) is the correct terminology for patients with a previous LVEF ≤40% (HFrEF) who now have an LVEF >40%. 1

Official Classification

The 2022 AHA/ACC/HFSA Guidelines explicitly define Heart Failure with Improved Ejection Fraction (HFimpEF) as:

  • Previous LVEF ≤40% (previously classified as HFrEF)
  • Follow-up measurement of LVEF >40% 1, 2

This classification applies regardless of whether the improved LVEF falls into the mildly reduced range (41-49%) or reaches preserved range (≥50%). 1

Key Terminology Distinctions

The guidelines deliberately chose "improved EF" rather than "recovered EF" or reclassifying these patients as HFpEF, even when LVEF improves to >50%. 1 This distinction is critical because:

  • Improvement does not equal full myocardial recovery: Cardiac structural abnormalities (LV chamber dilatation, systolic and diastolic dysfunction) typically persist despite LVEF improvement 1
  • LVEF changes are not unidirectional: Patients may experience subsequent decreases in EF depending on underlying cause, GDMT adherence, or reexposure to cardiotoxicity 1
  • Treatment withdrawal risk: EF can decrease after withdrawal of pharmacological treatment in many patients who had improved to normal range with GDMT 1

Clinical Management Implications

Patients with HFimpEF should continue HFrEF-directed therapy to prevent relapse, regardless of how much their EF has improved. 3 This represents a critical clinical pitfall—these patients remain fundamentally different from those with de novo HFpEF and require ongoing aggressive medical management. 1, 3

Prognostic Context

While HFimpEF is associated with better outcomes compared to persistent HFrEF (lower all-cause mortality, cardiovascular mortality, and hospitalization rates), 4, 5 these patients still carry residual risk. Research shows that 5.7% of patients with improved LVEF >35% still experienced significant ventricular tachyarrhythmias. 1

The threshold of >40% (not ≥40%) is intentional: An LVEF of exactly 40% remains classified as HFrEF, not HFimpEF. 1 This distinction matters clinically, as studies show substantial digit bias in EF reporting at the 40% threshold. 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Classification and Diagnosis of Heart Failure

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Classification and Management of Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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