HFrEF, HFmrEF, and HFpEF: Are They a Continuum or Different Faces of a Syndrome?

Abstract

Heart failure (HF) is a significant and growing public health problem. 1 Recent projections have shown that the prevalence of HF in the United States will increase by 46% between 2012 and 2030. 2 This is driven by an increase in the life expectancy of the population combined with a reduction in mortality from the disease resulting from advances in therapies in recent years.Of all the classifications of HF, the most used one is based on left ventricular ejection fraction (LVEF), which is categorized into three groups: HF with preserved ejection fraction (HFpEF) (LVEF ≥50%), HF with reduced ejection fraction (HFrEF) (LVEF ≤40%), and HF with moderate or mildly reduced ejection fraction (HFmrEF) (LVEF 41-49%). 3 Although the prognosis appears to be similar among HF subtypes based on ejection fraction, 4,5 there are differences between the groups in terms of clinicalepidemiologic profile and functional capacity.