Skill Checkup: A Woman With Long‐standing Hypertension and Worsening Dyspnea on Exertion

Yasmine S. Ali, MD


December 23, 2021

For patients with signs and symptoms of HF and an LVEF < 40%, the diagnosis is HFrEF. For those with signs and symptoms of HF and an LVEF of 41%-49%, the definition is HF with midrange EF (HFmrEF), and an LVEF ≥ 50% defines HFpEF.

The designation of HFmrEF is relatively new. Previously, an EF ≤ 49% was considered HFrEF. The concept of HFmrEF, though described many years ago, gained widespread acceptance in 2016, when the 2016 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic HF proposed the new HF classification. The ESC guidelines recommend therapies for HFmrEF on the basis of the evidence for HFpEF rather than that for HFrEF. However, in actual clinical practice, the treatment of HFmrEF is closer to that of HFrEF.


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