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Distinguishing Between Heart Failure Classifications

Opinion
Video

A panel of medical experts discuss various categories of heart failure and their clinical implications.

This is a video synopsis/summary of a panel discussion involving Robert Groves, MD; Eugene E. Wright Jr, MD; Nancy Albert, PhD, CCNS, CCRN, CHFN, NE-BC, FAHA, FCCM, FHFSA, FAAN; Nihar Desai, MD, MPH; and Kelly Marie Axsom, MD. Axsom provides an overview of the current heart failure classification system, which categorizes patients based on ejection fraction (EF) and symptoms. Heart failure with preserved ejection fraction (HFpEF) has EF over 50% with elevated natriuretic peptides or signs of elevated filling pressures. Heart failure with reduced ejection fraction (HFrEF) has EF under 40%. There is also a midrange between 40% and 49% EF. Patients can move between categories over time. Even asymptomatic patients with only mildly reduced EF could be considered early-stage heart failure, where treatments could prevent progression. Albert emphasizes that once a patient has heart failure symptoms, they have the diagnosis even if symptoms later resolve. Heart failure is a chronic condition requiring lifelong treatment, as stopping treatment often leads to recurrence of worse symptoms within 2 years. Patients may feel their symptoms are stable, but it is important that they understand they have persistent heart failure that requires ongoing care. The updated classification system allows clearer categorization and more tailored management based on EF and symptom status.

Video synopsis is AI-generated and reviewed by AJMC editorial staff.

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