Heart failure with reduced ejection fraction (HFrEF) means your left heart ventricle has weakened and less blood is being pumped into your body. HFrEF requires ongoing treatment to reduce the risk of complications.
HFrEF, also known as “systolic heart failure,” means your heart isn’t contracting as it should, causing less blood to reach your organs, muscles, and other tissues in your body.
The condition can cause a range of symptoms that may affect your daily life, from your energy level to the healthy functioning of your organs.
HFrEF can be the result of a heart attack or other cardiac condition. It’s usually treated with a combination of medications, lifestyle adjustments, and, if necessary, surgical procedures.
With proper management and a commitment to a heart healthy lifestyle, HFrEF may be something you can live with for a long time.
Ejection fraction is the percentage of blood pumped out of the left ventricle with each contraction.
HFrEF is specific to the left ventricle, which pumps blood out through the aorta to most of the body. The condition occurs when the left ventricle is too weak to pump a normal amount of blood.
When the percent of blood ejected from the heart has been reduced, it’s called “systolic heart failure.” A diagnosis of HFrEF means there’s an ejection fraction of
What is heart failure with preserved ejection fraction?
Heart failure with preserved ejection fraction (HFpEF) means your left ventricle has become too stiff to relax and fill up with an adequate supply of blood.
The ventricle is able to contract effectively and eject a normal percentage of blood from the chamber (
HFpEF is defined as greater than or equal to
HFpEF is called “diastolic heart failure” because “diastole” refers to the time when the ventricles relax and fill with blood in between contractions.
Shortness of breath is one of the main symptoms of systolic heart failure. It may develop after some physical exertion or when lying down. Advanced heart failure can sometimes cause shortness of breath that comes on at rest.
Some of the other more common symptoms of systolic heart failure include:
- chest pain
- confusion and difficulty concentrating
- coughing (sometimes with blood)
- heart palpitations
- more frequent urination, especially at night
- sudden weight gain
- swelling in the abdomen and/or limbs
If you notice significant swelling or unexpected weight gain over a period of 24 hours, try to see a doctor as soon as you can.
Diagnosing HFrEF usually starts with a review of your symptoms and medical history. A doctor should also conduct a physical examination and listen to your heart with a stethoscope.
Lab tests are also critical in making an accurate diagnosis. In particular, if HFrEF is suspected, you should have a blood test that includes the measurement of serum B-type natriuretic peptide levels or its N-terminal component.
Several cardiovascular conditions can result in HFrEF. Among these conditions are:
Treating HFrEF usually starts with one or more heart medications. Some of the more commonly prescribed medications for systolic heart failure include:
- aldosterone blockers
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin receptor blockers
angiotensin receptor-neprilysin inhibitors
- sodium-glucose cotransporter-2 inhibitors
Lifestyle behaviors may also require adjustments to support better heart health. Some of the behaviors you may want to prioritize are:
- regular exercise (consider enrollment in a
cardiac rehabilitation programto develop a safe exercise regimen)
- following a heart healthy diet that’s low in sodium
- drinking little or no alcohol
- managing your blood pressure, cholesterol, and blood glucose (sugar) levels
- if you smoke, consider quitting
For some people who have HFrEF, an implantable cardioverter defibrillator (ICD) may be necessary to keep a steady heart rhythm. An ICD is useful for the prevention of sudden cardiac death in people with ejection fractions
If your heart failure advances, you may require a left ventricular assist device, which is an artificial pump to support your heart.
HFrEF is a serious condition that can cause numerous life threatening complications.
A 2022 study suggests that the rate of “all-cause mortality” (death by any cause) for individuals with HFrEF, 1 year after diagnosis, is
HFrEF usually first presents with symptoms such as shortness of breath, which can be an indication of many other conditions. For this reason, HFrEF sometimes goes undiagnosed until it has progressed significantly.
If you’ve had a heart attack, have high blood pressure, or any other cardiac condition, don’t hesitate to respond quickly to symptoms to have HFrEF diagnosed early and treated promptly for the best possible outcome.