Heart failure (HF), traditionally classified by left ventricular ejection fraction (LVEF) cutpoints, overlooks its continuum and nuanced treatment responses. The Heart Failure Collaboratory advocates a pragmatic shift to broadly categorize HF into reduced and non-reduced LVEF, reflecting recent guidelines’ evolution. While terms like HFmrEF lack robust evidence and may complicate treatment decisions, HFimpEF should align with HFrEF due to shared characteristics.

Current HF treatments show varying efficacy across LVEF, challenging traditional classifications. Neurohormonal antagonists and sodium glucose co-transporter 2 inhibitors exhibit diverse treatment effects relative to LVEF, with diminishing benefits towards normal ranges. HF device interventions echo these disparities, underscoring the need for nuanced management strategies. While LVEF remains crucial in clinical practice, ongoing research should prioritize novel biomarkers and therapies for tailored interventions, enhancing outcomes across HF’s diverse landscape.

Reference: Dimond MG, Ibrahim NE, Fiuzat M, et al. Left Ventricular Ejection Fraction and the Future of Heart Failure Phenotyping. JACC Heart Fail. 2024 Mar;12(3):451-460. doi: 10.1016/j.jchf.2023.11.005. Epub 2023 Dec 13. PMID: 38099892.