The Heart Failure Society of America (HFSA) has released a new scientific statement encouraging the acceptance of heart failure with mildly reduced ejection fraction (HFmrEF) as its own distinct condition.1
Prior to the statement’s release, HFmrEF has largely been considered a gray zone in between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF), and as a result has been understudied. Initially identified by the European Society of Cardiology (ESC) in 2016 and termed heart failure with mid-range ejection fraction, clinical trials have historically overlooked this patient population, leading to limited available evidence.1,2
“There’s been a little confusion out there, especially in people who are outside of heart failure circles, as to who these patients are, whether they justify their own distinction, what we look for, how we treat them, et cetera,” Barry Borlaug, MD, associate professor of medicine at Mayo Clinic and co-author of the statement, told HCPLive in an exclusive interview. “That was really the basis for putting together this expert scientific statement.”
Borlaug and colleagues highlight shortcomings with current HF management and diagnosis, noting that although EF is typically used as a benchmark to differentiate between the major categories, it is an intrinsically imperfect measurement. EF is dependent on a variety of factors, including chamber size, which naturally decreases as chamber volume increases, as well as hemodynamic loading conditions.1
Given these limitations in standard disease identification, Borlaug and colleagues created a series of practical considerations for other clinicians, highlighting 5 major points in HFmrEF diagnosis, treatment, and management. These points include the following:
