Heart failure with reduced ejection fraction (HFrEF) is a type of heart failure where the heart’s pumping ability is weakened. This guide explains the condition, its causes, symptoms, treatments, and how to manage living with it.
What is Heart Failure with Reduced Ejection Fraction (HFrEF)?
HFrEF is a condition where the heart muscle becomes too weak to pump blood effectively to meet the body’s needs. The term “reduced ejection fraction” refers to the amount of blood pumped out of the heart’s main chamber (the left ventricle) with each beat. In HFrEF, this amount is significantly lower than normal, typically less than 40%.
This reduced pumping ability leads to symptoms such as breathlessness, fatigue, and fluid buildup in the body. HFrEF is also known as systolic heart failure, as it primarily affects the systolic phase (when the heart contracts and pumps blood).
Key Facts About HFrEF
Background
- Heart failure is a leading cause of hospitalisation worldwide, and HFrEF accounts for approximately half of all cases.
- It is a chronic condition that requires lifelong management but can be stabilised with appropriate treatment.
Causes
HFrEF occurs when the heart muscle is damaged or weakened. Common causes include:
- Coronary artery disease: Blockages in the arteries that supply blood to the heart can damage the heart muscle.
- Heart attack (myocardial infarction): A sudden blockage in a coronary artery can lead to permanent damage to part of the heart muscle.
- High blood pressure (hypertension): Over time, this can strain and weaken the heart.
- Cardiomyopathy: Diseases of the heart muscle, which may be caused by genetics, infections, or alcohol abuse.
- Valvular heart disease: Problems with the valves that regulate blood flow through the heart.
Incidence and Prevalence
- Incidence: Around 1–2 new cases per 1,000 people are diagnosed each year globally.
- Prevalence: Approximately 1–2% of adults have heart failure, but this rises to over 10% in people aged 70 and older.
Who is Affected?
- Age: HFrEF can occur at any age but is more common in people over 50 years old.
- Gender: Men are more likely than women to develop HFrEF, while women are more commonly affected by HFpEF (heart failure with preserved ejection fraction).
- Ethnicity: HFrEF occurs in all ethnic groups but may be more prevalent in populations with higher rates of risk factors like hypertension or diabetes.
Geographic Distribution
- HFrEF is a global health issue but is more common in developed countries due to longer life expectancy and higher rates of conditions like obesity and coronary artery disease.
How Does HFrEF Impact You?
Symptoms
The symptoms of HFrEF can vary depending on its severity but often include:
- Shortness of breath during physical activity or when lying down.
- Fatigue or weakness that interferes with daily activities.
- Swelling (oedema) in the legs, ankles, feet, or abdomen due to fluid retention.
- Persistent cough or wheezing, often worse at night.
- Rapid or irregular heartbeat (palpitations).
These symptoms can significantly affect your quality of life and ability to perform daily tasks.
Living With Heart Failure with Reduced Ejection Fraction
Living with HFrEF involves managing symptoms through lifestyle changes, medications, and regular medical care. It’s important to monitor your symptoms closely and report any changes to your healthcare provider.
Expected Life Expectancy
HFrEF is a serious condition that can reduce life expectancy if untreated. However, advances in treatment have improved survival rates significantly for many patients.
Managing and Treating HFrEF
Available Treatments
Treatment for HFrEF focuses on relieving symptoms, improving quality of life, and slowing disease progression:
- Medications:
- Beta-blockers: Help reduce strain on the heart by slowing your heartbeat and lowering blood pressure (e.g., bisoprolol, carvedilol).
- ACE inhibitors or ARBs: Relax blood vessels and reduce workload on the heart (e.g., enalapril, losartan).
- ARNIs (angiotensin receptor-neprilysin inhibitors): A newer class of medication that improves outcomes by reducing strain on the heart (e.g., sacubitril/valsartan).
- Mineralocorticoid receptor antagonists (MRAs): Reduce fluid retention and improve survival (e.g., spironolactone).
- Diuretics: Help reduce fluid buildup in your body but do not directly improve survival (e.g., furosemide).
- Lifestyle Changes:
- Follow a low-sodium diet to prevent fluid retention.
- Engage in regular physical activity appropriate for your condition.
- Avoid smoking and limit alcohol intake.
- Maintain a healthy weight.
- Device-Based Therapies: For some patients with severe symptoms or arrhythmias:
- Implantable cardioverter-defibrillators (ICDs): Prevent sudden cardiac death by correcting dangerous heart rhythms.
- Cardiac resynchronisation therapy (CRT): Improves coordination between different parts of your heart.
- Surgical Options:
- Coronary artery bypass grafting (CABG) or valve repair/replacement may be considered if structural issues contribute to HFrEF.
- In advanced cases, a heart transplant may be an option.
Ongoing Clinical Research
Research into HFrEF continues to explore new treatments and ways to improve outcomes for patients:
- Gene Therapy: Investigating ways to repair damaged heart tissue at a genetic level.
- New Medications: Trials are underway for drugs targeting inflammation and fibrosis (scarring) in the heart.
- Biomarkers: Researchers are identifying biomarkers that could help predict disease progression or response to treatment. For information on clinical trials related to HFrEF, visit clinicaltrials.gov.
Support Groups and Resources
If you have been diagnosed with HFrEF, connecting with support groups can provide valuable information and emotional support:
- British Heart Foundation (BHF) (org.uk) – Offers resources for individuals living with heart failure.
- Heart Failure Matters (org)– Provides educational materials on managing heart failure.
- Pumping Marvellous Foundation (org)– A UK-based patient-led organisation offering support for people living with heart failure.
- American Heart Association (AHA) (org)– Offers global resources on cardiovascular health.Remember:This information is intended for general knowledge and educational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
