Heart Health

Heart failure, mildly reduced ejection fraction

Ejection fraction — the number that decides the whole regimen 41–49% (mildly reduced)

Recommendationhf-mrefNo one has reached this rule yet

SGLT2 inhibitor first; the other three reasonable to add

Clinical review

All reviewers

No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.

What someone who reaches this rule is told

Word for word, as generated for the example person below. Figures in the text are theirs.

  • Reasonable to do

    Your ejection fraction is 45%, in the mildly-reduced band. An SGLT2 inhibitor is the best-supported option; the other three classes may be considered.

    Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.

    ACC/AHAClass 2aLevel B-R
    Why, and the source

    Dapagliflozin and empagliflozin reduced heart failure hospitalizations across this range, regardless of diabetes. An ARNI (or ACE inhibitor/ARB), a heart-failure beta blocker, and an MRA all have weaker evidence in this band than they do below 40%. The guideline says they may be considered, particularly toward the lower end of the band, and they become clearly indicated if your ejection fraction drops further. Because this band sits on a boundary, it's worth repeating the echocardiogram rather than assuming the number is fixed.

    Where the guidelines stand

    ACC/AHA (US)

    2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (Circulation) · Class 2a · Level B-R

An example person who reaches it

“Heart failure, mildly reduced” — an illustrative profile, not a real user.

70-year-old manBP 124/78LDL 120heart failure, EF 45%10-yr PREVENT-ASCVD 7.9%

Their path through heart failure

  1. Diagnosed heart failure?Yes
  2. Ejection fraction — the number that decides the whole regimen41–49% (mildly reduced) ← this rule
  3. Care that applies at any ejection fractionAlways

Where it sits

Asked after: Heart failure

Sources

Cited by the recommendations above.

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Runs in lib/engine/heartFailurePathway.ts as hf-mref.