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CSI 2021: What is Mildly Reduced Heart Failure?

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Dr BKS Sastry, Hyderabad    01 January 2022

The European Society of Cardiology (ESC) guidelines for the diagnosis and management of heart failure (HF) talked about a new group of patients – patients having HF with mildly reduced ejection fraction (HFmrEF). According to the guidelines, the diagnostic criteria for HFmrEF encompass signs and symptoms of HF, ejection fraction (EF) of 40‑49%, raised natriuretic peptide levels with prominent structural heart disease, such as left ventricular hypertrophy or left atrial enlargement or diastolic dysfunction.

The prevalence of HFmrEF among patients with HF has been reported to be around 10‑25%. It seems to represent an intermediate clinical entity between HFrEF and HFpEF; however, it has more similarity with HFrEF in some aspects, especially when it comes to the high prevalence of ischemic heart disease in these patients. HFmrEF is milder than HFrEF, with a lower risk of CV events in patients with HFmrEF or HFpEF compared to HFrEF. The risk of non-CV adverse events is; however, similar or even higher in patients with HFmrEF or HFpEF. Some post hoc and subgroup analyses of randomized clinical trials as well as a trial of an SGLT1-SGLT2 inhibitor indicate that drugs known to be effective in HFrEF might also work in patients with HFmrEF. More focused research can be conducted on this new subset of patients in order to have a better understanding of this patient group and devise tailored management approaches.

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