Heart Failure With Mildly Reduced Ejection Fraction

Document Overview

Document Title

Heart Failure With Mildly Reduced Ejection Fraction

Authoring Society

Heart Failure Society of America

Document Publication Date

Apr 22, 2026

Page Last Reviewed/Updated

Apr 23, 2026

Document Type

Consensus

Country of Publication

United States

Full Text Freely Available

No

Full Text Guideline

onlinejcf.com/article/S1071-9164(26)00134-X/abstract

Source Citation

JANE E. WILCOX, LARS H. LUND, ZACHARY L. COX, JENNIFER E. HO, CAROLYN S.P. LAM, KAVITA SHARMA, BARRY A. BORLAUG, Heart Failure With Mildly Reduced Ejection Fraction: A Heart Failure Society of America Scientific Statement, Journal of Cardiac Failure, 2026, ISSN 1071-9164, https://doi.org/10.1016/j.cardfail.2026.01.024

Supplemental Implementation Resources

• Graphical Abstract

Document Scope, Criteria, and Use Cases

Document Objectives

Heart failure (HF) has been categorized for years according to ejection fraction (EF) into patients with reduced (HFrEF) and preserved EF (HFpEF). In 2016, guidelines from the European Society of Cardiology recognized a third group, initially termed HF with mid-range EF (HFmrEF, originally 40−49%, but now modified to 41−49%), which has more recently been renamed HF with mildly reduced EF. HFmrEF predictably shares features with both HFrEF and HFpEF, but evidence to guide treatment is limited because clinical trials specifically restricted to this patient population have been lacking. The purpose of this Heart Failure Society of America Scientific Statement is to provide a comprehensive review of the epidemiology, clinical characteristics, and pathophysiology and to put forth a clinical framework for the treatment of patients with HFmrEF, for whom randomized trial data are limited.

 

Highlights

• Since 2016, guidelines from the ESC have recognized a third group, initially termed HF with mid-range EF (HFmrEF, originally 40−49%, but now modified to 41−49%), which has more recently been renamed HF with mildly reduced EF.
• HFmrEF predictably shares features with both HFrEF and HFpEF, but evidence to guide treatment is limited because clinical trials specifically restricted to this patient population have been lacking.
• The purpose of this Heart Failure Society of America Scientific Statement is to provide a comprehensive review of the epidemiology, clinical characteristics, and pathophysiology, and to put forth a clinical framework for the treatment of patients with HFmrEF, where randomized trial data is limited.

Scope

Management

Diseases/Conditions (MeSH)

D006333 - Heart Failure

Keywords

HFrEF, heart failure, heart failure with reduced ejection fraction (HFrEF)

Inclusion Criteria

Male, Female, Adult, Older Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant