# Heart failure with reduced ejection fraction (HFrEF)

Condition · id `cardio:hfref` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public)

> General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here.

The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations.

Also called: HFrEF; Systolic heart failure

Browse, organ or system: Heart  
Browse, condition area: Heart failure  

## In plain language

The type of heart failure in which the left side of the heart is weak and cannot pump enough blood out. A US government patient page says it is diagnosed when the left ventricle pushes out 40% or less of its blood on each beat. Three medicine trials in this atlas (DAPA-HF, EMPEROR-Reduced and PARADIGM-HF) enrolled people with an ejection fraction of 40% or less. A registry of US outpatients with this type found that many were not prescribed each recommended medicine class or were not taking target doses.

## Technical summary

Defined here by the trial entry rule of an ejection fraction of 40% or less (DAPA-HF, EMPEROR-Reduced and PARADIGM-HF abstracts) and by a US government diagnosis page, which also says 40% or less. That page says long-term conditions that harm the heart muscle, for example coronary heart disease and heart attack, are the main cause of this type. Its treatment page lists several medicine groups as commonly used for it: diuretics, medicines that block the hormone aldosterone, ACE inhibitors or ARBs, medicines that block beta receptors, and others. The MeSH heading Heart Failure, Systolic (D054143) is wider than this record and is a broad match.

## Connected pages

- HFrEF is a type of heart failure: Heart failure (`cardio:heart-failure`)
- Files under this front: Medicines (`cardio:front-medicines`)
- Related to: Left ventricular ejection fraction (LVEF) (`cardio:lvef`)
- Related to: Many people with HFrEF do not receive all recommended medicines at target doses (`cardio:bottleneck-hfref-medicine-gaps`)
- Treated by: Dapagliflozin (`cardio:dapagliflozin`) [a claim, not a settled fact; see claim `cardio:claim-dapa-hf-primary-effect` and its context]
- Treated by: Empagliflozin (`cardio:empagliflozin`) [a claim, not a settled fact; see claim `cardio:claim-emperor-reduced-primary-effect` and its context]
- Treated by: Sacubitril/valsartan (combination) (`cardio:sacubitril-valsartan`) [a claim, not a settled fact; see claim `cardio:claim-paradigm-hf-primary-effect` and its context]
- Recommended for this: SGLT2 inhibitors (drug class) (`cardio:sglt2-inhibitors`) [a claim, not a settled fact; see claim `cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref` and its context]
- Investigated in: DAPA-HF (`cardio:dapa-hf`)
- Investigated in: EMPEROR-Reduced (`cardio:emperor-reduced`)
- Investigated in: PARADIGM-HF (`cardio:paradigm-hf`)

## Provenance

Content hash: d2d091573c4e1f096435e6b57c11e2442752d15d9570f6f7e3489ff9ddd09687
Last substantive edit: 2026-10-15
Evidence last checked: 2026-10-14