Table 1. Definitions of HFr EF and HFp EF
Classification
EF
Description
I. Heart failure
with reduced
ejection fraction
(HFrEF)
≤40%
Also referred to as "systolic HF." Randomized clinical
trials have mainly enrolled patients with HFrEF, and it
is only in these patients that efficacious therapies have
been demonstrated to date.
II. Heart failure
with preserved
ejection fraction
(HFpEF)
≥50%
Also referred to as "diastolic HF." Several different
criteria have been used to further define HFpEF. The
diagnosis of HFpEF is challenging because it is largely
one of excluding other potential noncardiac causes
of symptoms suggestive of HF. To date, efficacious
therapies have not been identified.
IIa. HFpEF,
borderline
41%–
49%
These patients fall into a borderline or intermediate
group. Their characteristics, treatment patterns, and
outcomes appear similar to those of patients with
HFpEF.
IIb. HFpEF,
improved
>40%
It has been recognized that a subset of patients with
HFpEF previously had HFrEF. These patients with
improvement or recovery in EF may be clinically
distinct from those with persistently preserved or
reduced EF. Further research is needed to better
characterize these patients.
Epidemiology
ÎÎThe lifetime risk of developing HF is 20% for Americans ≥40 years of
age.
ÎÎOver the last several decades, >650,000 new HF cases have been
diagnosed annually.
ÎÎApproximately 5.1 million persons in the United States have clinically
manifest HF, and the prevalence continues to rise as the population
ages.
ÎÎ5-year HF mortality is 50%.
ÎÎBlack men have the highest risk; white women have the lowest.
3
