Nora Eccles Harrison Cardiovascular Research & Training Institute

What Is Heart Failure with Reduced Ejection Fraction (HFrEF) and How Is It Diagnosed?

heart blood

What Is Heart Failure with Reduced Ejection Fraction (HFrEF) and How Is It Diagnosed?

Heart failure with reduced ejection fraction (HFrEF) is a serious condition that affects the heart’s ability to pump blood efficiently. It is one of the most common types of heart failure and is characterized by a weakened heart muscle that cannot contract forcefully enough to push enough blood throughout the body.

What Is Heart Failure with Reduced Ejection Fraction (HFrEF)?

Heart failure occurs when the heart cannot pump blood effectively, leading to inadequate circulation and oxygen delivery to the body’s organs and tissues. In HFrEF, the ejection fraction, a measure of how much blood the heart pumps out with each contraction, is reduced.

Ejection fraction (EF) is expressed as a percentage, with a normal EF ranging between 50% and 70%. In individuals with HFrEF, the EF is typically 40% or lower. This reduction indicates that the left ventricle is weakened and unable to eject enough blood with each beat.

How is HFrEF Diagnosed?

Diagnosing heart failure with reduced ejection fraction involves a combination of clinical evaluation, imaging tests, and laboratory studies. The diagnostic process typically includes:

  • Medical History and Physical Examination: A healthcare provider will ask about symptoms and risk factors.
  • Echocardiogram: An echocardiogram is the primary test used to diagnose HFrEF. It uses ultrasound waves to create images of the heart.
  • Electrocardiogram: This test records the heart’s electrical activity and can detect irregular heart rhythms, past heart attacks, or other abnormalities.
  • Blood Tests: Blood tests, including B-type natriuretic peptide or N-terminal pro-BNP, help assess the severity of heart failure.
  • Chest X-ray: This imaging test can reveal an enlarged heart or lung fluid buildup.
  • Cardiac MRI or CT Scan: In some cases, additional imaging tests such as cardiac MRI or CT scans may be used.
  • Stress Testing and Cardiac Catheterization: If coronary artery disease is suspected as the underlying cause, stress tests or cardiac catheterization may be performed.

What Are the Symptoms of a Reduced Ejection Fraction?

The symptoms of HFrEF can range from mild to severe and tend to worsen over time if left untreated. Common symptoms include:

  • Shortness of Breath: Often occurs during physical activity or while lying down due to fluid buildup.
  • Fatigue and Weakness:  Inadequate oxygen-rich blood reaching the body’s muscles and organs.
  • Swelling: Commonly affects the legs, ankles, and feet due to fluid retention.
  • Rapid or Irregular Heartbeat: The heart may compensate for its weakened function by beating faster or irregularly.
  • Persistent Cough or Wheezing: Can be caused by fluid accumulation in the lungs.
  • Sudden Weight Gain: A result of fluid retention, which may indicate worsening heart failure.
  • Difficulty Concentrating or Confusion: Reduced blood flow to the brain can lead to cognitive difficulties.

What Is the First-Line Treatment for HFrEF?

Managing HFrEF requires a comprehensive approach that includes lifestyle changes, medications, and sometimes medical devices or surgery. The primary goal of treatment is to improve heart function, alleviate symptoms, and reduce the risk of complications.

Medications

First-line treatments for HFrEF typically include:

  • Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARBs): These medications help relax blood vessels, lower blood pressure, and reduce strain on the heart.
  • Beta-Blockers: Improve heart function by slowing the heart rate and reducing blood pressure.
  • Mineralocorticoid Receptor Antagonists (MRAs): These include spironolactone, which helps decrease fluid retention and lower blood pressure.
  • Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors: A newer class of medications that benefits heart failure patients by reducing hospitalization rates and mortality.
  • Diuretics: Help eliminate excess fluid to relieve swelling and shortness of breath symptoms.

Lifestyle Modifications

  • Dietary Changes: Reducing sodium intake can help prevent fluid retention and reduce strain on the heart.
  • Regular Physical Activity: Moderate exercise can improve heart function and well-being.
  • Weight Management: Maintaining a healthy weight can reduce stress on the heart.
  • Smoking Cessation and Alcohol Moderation: Both smoking and excessive alcohol consumption can worsen heart failure symptoms.

Advanced Therapies

For patients with severe HFrEF who do not respond to standard treatments, additional interventions may be needed:

  • Implantable Cardioverter-Defibrillator (ICD): A device that helps prevent life-threatening arrhythmias.
  • Cardiac Resynchronization Therapy (CRT): A specialized pacemaker that helps coordinate the heart’s contractions.
  • Heart Transplant or Left Ventricular Assist Device (LVAD): Options for end-stage heart failure patients who have exhausted other treatment methods.

The Importance of Diagnosis, Health Management, and Care in HFrEF

Heart failure with reduced ejection fraction (HFrEF) is a serious condition that requires being diagnosed early and proper management to improve patient outcomes. Through a combination of medical therapies, lifestyle changes, and advanced treatments, many individuals with HFrEF can lead fulfilling lives while managing their condition.