Heart failure with mildly reduced or preserved ejection fraction

Overview

Classification codes

• MeSH read 2026-10-14 D054144

Burden

No burden claims are published.

Claims and evidence

No claims are published for this condition yet.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

• Claim, not a settled fact Treated by: Dapagliflozin (Claimed to treat, seen from the other side)

  Applies to Adult

  • Patients with heart failure and a left ventricular ejection fraction of more than 40%, who were taking usual therapy. The registry gives a minimum age of 40 years. The abstract says results were similar in people with an ejection fraction of 60% or more and those below 60%, and in subgroups including patients with or without diabetes.
  • Not stated in the abstract. The registry record is not read for setting.
  • Multinational: the registry lists many countries across several continents.
  • Adults, 40 years and over (registry minimum age).

  Follow-up Median 2.3 years (abstract).
  In DELIVER, adults with heart failure and a left ventricular ejection fraction of more than 40% took dapagliflozin 10 mg once daily or matching placebo, in addition to usual therapy. Over a median of 2.3 years, the primary outcome, worsening heart failure (an unplanned hospitalization or an urgent visit for heart failure) or cardiovascular death, occurred in 512 of 3131 people (16.4%) taking dapagliflozin and 610 of 3132 (19.5%) taking placebo (hazard ratio 0.82, 95% CI 0.73 to 0.92). Worsening heart failure alone occurred in 368 people (11.8%) and 455 (14.5%) respectively (hazard ratio 0.79, 95% CI 0.69 to 0.91). Cardiovascular death alone occurred in 231 people (7.4%) and 261 (8.3%) (hazard ratio 0.88, 95% CI 0.74 to 1.05); the confidence interval includes 1, so the abstract does not show a difference in cardiovascular death on its own. The authors report that results were similar in people with an ejection fraction of 60% or more and those below 60%, and in prespecified subgroups including patients with or without diabetes, and that the incidence of adverse events was similar in the two groups.

  Limitations. One placebo-controlled trial funded by AstraZeneca. The numbers come from the PubMed abstract; the full text, tables and registry results were not read. Worsening heart failure alone had a hazard ratio of 0.79 (0.69 to 0.91); cardiovascular death alone had 0.88 (0.74 to 1.05), an interval that includes 1. The abstract title says mildly reduced or preserved ejection fraction, while the registry condition says preserved. No certainty rating was assessed.

• Claim, not a settled fact Treated by: Empagliflozin (Claimed to treat, seen from the other side)

  Applies to Adult

  • Patients with class II to IV heart failure and an ejection fraction of more than 40%, who were taking usual therapy. The registry gives a minimum age of 18 years. The abstract says the effects appeared consistent in people with and without diabetes. The trial includes people with mildly reduced as well as preserved ejection fraction.
  • Not stated in the abstract. The registry record is not read for setting.
  • Multinational: the registry lists many countries across several continents.
  • Adults, 18 years and over (registry minimum age). The abstract gives no mean age.

  Follow-up Median 26.2 months (abstract).
  In EMPEROR-Preserved, adults with class II to IV heart failure and an ejection fraction of more than 40% took empagliflozin 10 mg once daily or placebo, in addition to usual therapy. Over a median of 26.2 months, the primary outcome, cardiovascular death or hospitalization for heart failure, occurred in 415 of 2997 people (13.8%) taking empagliflozin and 511 of 2991 (17.1%) taking placebo (hazard ratio 0.79, 95% CI 0.69 to 0.90). The authors say this effect was mainly related to a lower risk of hospitalization for heart failure with empagliflozin. Separately, the total number of hospitalizations for heart failure was 407 with empagliflozin and 541 with placebo (hazard ratio 0.73, 95% CI 0.61 to 0.88); these are counts of events and not of people. The effects appeared consistent in people with or without diabetes. Uncomplicated genital and urinary tract infections and low blood pressure were reported more often with empagliflozin.

  Limitations. One double-blind trial funded by Boehringer Ingelheim and Eli Lilly. The numbers come from the PubMed abstract; the full text, tables and registry results were not read. The abstract does not give the separate counts for cardiovascular death, so the claim does not say whether death alone differed. The trial enrolled people with an ejection fraction above 40%, a wider band than the preserved range NHLBI describes. No certainty rating was assessed.

• Claim, not a settled fact Evaluated for this: Finerenone (Evaluated for, seen from the other side)

  Applies to Recipient not specified

  • Patients with heart failure and a left ventricular ejection fraction of 40% or greater, which covers mildly reduced and preserved ejection fraction.
  • International, double-blind, randomized trial; the abstract does not describe the care setting further.
  • International, according to the abstract. The countries were not read.
  • Not stated in the abstract.
  • Gestational age Not reported
  • Postnatal age Not reported

  Follow-up Median follow-up 32 months.
  In FINEARTS-HF, patients with heart failure and a left ventricular ejection fraction of 40% or greater were randomly assigned, in a 1:1 ratio, to finerenone or matching placebo, each on top of usual therapy; the finerenone dose was titrated to a maximum of 20 mg or 40 mg once daily. The primary outcome counted two things together: total worsening heart failure events (first or repeat unplanned hospitalizations or urgent visits for heart failure) and death from cardiovascular causes. Over a median follow-up of 32 months, 1083 primary-outcome events occurred in 624 of 3003 patients on finerenone and 1283 events in 719 of 2998 patients on placebo (rate ratio 0.84; 95% CI 0.74 to 0.95; P=0.007). Worsening heart failure events alone numbered 842 on finerenone and 1024 on placebo (rate ratio 0.82; 95% CI 0.71 to 0.94; P=0.006). Death from cardiovascular causes occurred in 8.1% and 8.7% of patients (hazard ratio 0.93; 95% CI 0.78 to 1.11), an interval that includes 1. Finerenone was associated with more hyperkalemia and less hypokalemia.

  Limitations. One double-blind trial, funded by Bayer (named in the abstract). Only the PubMed abstract was read, not the full paper, and the registry record the abstract names (NCT04435626) was not read. The abstract gives no age limits and no certainty grade. The primary outcome is a composite. Total worsening heart failure events alone were also lower, while for cardiovascular death alone the confidence interval included 1. The abstract gives no size for the hyperkalemia and hypokalemia findings. The ejection fraction band of 40% or greater covers the mildly reduced and the preserved range, and it includes 40% itself, which NHLBI counts in the reduced range, so the result is not specific to the mildly reduced or the preserved type.

Record details

Record id

cardio:hfpef

Content hash

5ab97116dea4be80c1a70f2a1fb424a986da97dbe25784535ba01058bf02380b