“…Heart failure (HF) with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF) together constitute the majority of HF in the contemporary era and are associated with substantial death, disability, and healthcare costs. [1][2][3] Identification of therapeutic pathways to ameliorate symptom burden and functional impairment remains a central priority in the clinical care of this at-risk population, for whom evidence-based therapeutic options have been historically lacking. 4 Although with important limitations, [5][6][7][8] the New York Heart Association (NYHA) functional classification is independently predictive of mortality irrespective of left ventricular ejection fraction (LVEF), [9][10][11] is recommended in current international HF clinical practice guidelines to guide treatment eligibility, 12,13 and therein remains an important clinical metric widely used in clinical practice to characterize symptom burden and functional capacity.…”