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➤ Classifying HF by LVEF
• HF is categorized based on LVEF and clinical stage. HFrEF is defined
by LVEF ≤40%; HF with improved EF refers to patients with prior
LVEF ≤40% and subsequent improvement to >40%; HF with mildly
reduced EF (HFmrEF) is characterized by LVEF 41% to 49%. HFpEF
is defined by LVEF ≥50% with evidence of elevated or inducible
left ventricular filling pressures (increased natriuretic peptides or
abnormal hemodynamics). Staging of HF progresses from:
▶ Stage A: individuals at risk without symptoms or cardiac
abnormalities.
▶ Stage B (pre-HF): structural heart changes or persistently
elevated biomarkers without symptoms.
▶ Stage C: structural heart disease with current or prior symptoms.
▶ Stage D: ref ractory, advanced HF with severe symptoms and
repeated hospitalizations despite optimal management.
