{
  "release_id": "f6f6f1b6f50379ed",
  "id": "cardio:hfref",
  "owner": "cardio",
  "kind": "condition",
  "slug": "hfref",
  "name": "Heart failure with reduced ejection fraction (HFrEF)",
  "aliases": [
    "HFrEF",
    "Systolic heart failure"
  ],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "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.",
  "summary_technical": "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.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [
    {
      "scheme": "mesh",
      "value": "D054143",
      "normalized_value": "D054143",
      "match": "broad",
      "version": "read 2026-10-14",
      "label": null,
      "from_source": false
    }
  ],
  "navigation": {
    "cardio": {
      "system": [
        "heart"
      ],
      "condition-area": [
        "heart-failure"
      ]
    }
  },
  "payload": {
    "recognition": null,
    "assessment": null,
    "burden_claims": []
  },
  "content_digest": "d2d091573c4e1f096435e6b57c11e2442752d15d9570f6f7e3489ff9ddd09687",
  "review": {
    "content_digest": "d2d091573c4e1f096435e6b57c11e2442752d15d9570f6f7e3489ff9ddd09687",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "subtype_of",
        "label": "HFrEF is a type of heart failure",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:heart-failure",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": true,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "part_of",
        "label": "Files under this front",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:front-medicines",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": true,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": [
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:lvef",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:bottleneck-hfref-medicine-gaps",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "treats",
        "label": "Treated by",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:dapagliflozin",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-dapa-hf-primary-effect",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "treats",
        "label": "Treated by",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:empagliflozin",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-emperor-reduced-primary-effect",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "treats",
        "label": "Treated by",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:sacubitril-valsartan",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-paradigm-hf-primary-effect",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "recommended_for",
        "label": "Recommended for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:sglt2-inhibitors",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:dapa-hf",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct03036124-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[0]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:emperor-reduced",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct03057977-2026-10-14",
          "locator": "protocolSection.identificationModule.briefTitle"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:paradigm-hf",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct01035255-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[0]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ]
  },
  "page_path": "conditions/hfref/",
  "context_path": "api/v1/context/cardio--hfref.md"
}