The current classification of heart failure is obsolete

A recent consensus document on the use of the left ventricular ejection fraction (LVEF) in the diagnosis and management of heart failure has suggested that, based on measurements of LVEF, patients may be classified into one of the following groups: HFrEF (heart failure with reduced LVEF ≤40%); HFmrEF (heart failure with mildly reduced LVEF 41%–49%); HFpEF (heart failure with preserved LVEF 50%–65%); HFsnEF (heart failure with supra-normal LVEF >65%) and, recognizing that LVEF often changes with treatment or disease progression, further classified as HFrecEF (heart failure with recovered LVEF); HFuncEF (heart failure with unchanged LVEF); and HFworEF (heart failure with worsening LVEF).1 These recommendations are designed to replace current heart failure guidelines that had only three categories: HFrEF, HFmrEF, and HFpEF.2,3 Slicing LVEF into a complex, often arbitrary constellation of subgroups may not be in the best interests of science, medicine, doctors, or patients when the precision with which LVEF can be measured by echocardiography, the most widely used imaging method, is little more than 10%. The overlap amongst groups will be substantial. Indeed, a strong argument for the HFmrEF category is to allow clear separation of HFrEF from HFpEF by creating a zone of uncertainty where the clinician must exercise judgement in deciding the value of treatments indicated for HFrEF but not for HFpEF (e.g. beta-blockers).