Heart Failure with Reduced Ejection Fraction: Key Facts, Symptoms, Diagnosis, and Management

Learn about the causes, symptoms, diagnosis, treatment, and outlook for heart failure with reduced ejection fraction (HFrEF)—a serious condition impacting heart function.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 25, 2025

Heart Failure with Reduced Ejection Fraction (HFrEF)

Heart failure with reduced ejection fraction (HFrEF) is a condition in which the left ventricle of the heart weakens, leading to less blood being pumped into the body. This can cause a range of symptoms, affect organ health, and impact daily life. HFrEF is also known as systolic heart failure because it is marked by a decrease in the heart’s ability to contract and eject blood effectively.

Overview

HFrEF means your heart isn’t pumping blood efficiently, resulting in less oxygen-rich blood reaching organs and tissues.
The condition requires ongoing management—with medications, lifestyle changes, and sometimes surgical procedures.
With proper care, many people with HFrEF can manage the condition over the long term.

To understand the broader spectrum of heart failure, it’s crucial to learn about heart failure with preserved ejection fraction (HFpEF). Unlike HFrEF, HFpEF is characterized by a stiff heart muscle that can still pump blood effectively under certain conditions. It’s essential to explore these differences to grasp how each type affects overall health. By understanding the full range of heart failure, you can make informed decisions about your treatment and management options.

What is Ejection Fraction?

“Ejection fraction” refers to the percentage of blood pumped out of the left ventricle during each heartbeat.

Ejection Fraction (%)	Heart Activity	Clinical Significance
55–70%	Normal contraction	Healthy heart function
40% or below	Reduced contraction	Indicates HFrEF
Above 70%	Usually abnormal thickening	Possible hypertrophic cardiomyopathy

HFrEF is diagnosed when the ejection fraction is 40% or less. In this condition, the left ventricle is too weak to pump blood normally; individuals may experience symptoms related to poor circulation and reduced organ perfusion.

How Does HFrEF Differ from Other Types of Heart Failure?

Heart failure with reduced ejection fraction (HFrEF): Heart muscle is too weak and does not contract properly, reducing the amount of blood pumped to the body.
Heart failure with preserved ejection fraction (HFpEF): Heart muscle is stiff and cannot relax fully; ejection fraction may remain normal but the heart fills with less blood, still resulting in inadequate circulation.

Recognizing the symptoms of heart failure is vital for timely intervention. If you want to know more about how to identify early signs of heart failure, check out our guide on recognizing and managing symptoms of congestive heart failure. By equipping yourself with this knowledge, you can take proactive steps toward better heart health and discuss any concerns with your healthcare provider sooner rather than later.

Your doctor may order diagnostic tests to distinguish between HFrEF and HFpEF, such as:

Echocardiogram
Nuclear stress test
Cardiac catheterization
CT scan

Symptoms of HFrEF

The symptoms of heart failure with reduced ejection fraction may vary in intensity and presentation. They often develop gradually, but sudden or worsening symptoms require urgent medical attention.

Shortness of breath (especially on exertion or when lying down)
Fatigue and weakness
Swelling (edema) in legs, ankles, feet, or abdomen
Rapid or irregular heartbeat
Persistent cough or wheezing (sometimes with pink, frothy sputum)
Difficulty exercising or performing daily activities
Sudden weight gain due to fluid retention
Frequent need to urinate at night (nocturia)
Decreased appetite or nausea

If you’re uncertain whether your symptoms are linked to heart failure, consider exploring our insights on recognizing and managing congestive heart failure symptoms. Having clear information about the warning signs can empower you to seek medical advice promptly and make sense of your health situation. Acknowledging these symptoms early can make all the difference in your treatment journey.

When to Seek Immediate Medical Help

Severe shortness of breath
Chest pain
Sustained rapid or irregular heartbeat
Fainting or severe dizziness

If any of these symptoms occur or worsen suddenly, seek emergency medical care.

Diagnosis of HFrEF

A thorough diagnosis of heart failure with reduced ejection fraction involves multiple steps, including clinical evaluation, laboratory testing, and imaging.

Medical history and physical examination: Doctors assess risk factors, symptoms, and any previous cardiac events.
Blood tests: Measurement of levels of natriuretic peptides (such as BNP and NT-proBNP), which may be elevated in heart failure.
Imaging tests: The main method for assessing ejection fraction is the echocardiogram. Other imaging like CT scans, cardiac MRI, or nuclear stress tests may be used as needed.
Electrocardiogram (ECG): To identify arrhythmias, left ventricular hypertrophy, or previous heart attacks.
Chest X-ray: To check for heart enlargement or fluid in the lungs.

A comprehensive evaluation is crucial for understanding your heart health. For an in-depth look at the early signs, diagnosis, and treatment of heart failure, be sure to read our detailed overview of congestive heart failure symptoms. This resource will guide you through what to expect during diagnosis and how to take charge of your heart health effectively.

Diagnostic criteria for HFrEF include an ejection fraction of 40% or less, symptoms consistent with heart failure, and evidence of left ventricular systolic dysfunction.

Causes and Risk Factors

There are several underlying causes and risk factors that increase the possibility of developing HFrEF.

It’s important to understand not only HFrEF but also related conditions such as diastolic heart failure. Explore our thorough overview on diastolic heart failure: symptoms, diagnosis, and management. This exploration can help you understand the interconnectedness of heart conditions and how age-related changes can influence your health trajectory.

Coronary artery disease (including previous heart attack): Blockages in heart arteries can damage the heart muscle.
Cardiomyopathy: Weakened heart muscle, either from genetics, infections, high blood pressure, or toxin exposure.
Heart valve disease: Malfunction of valves leading to disrupted blood flow and extra strain on the ventricles.
High blood pressure (hypertension): Chronic pressure forces the heart to work harder, eventually weakening the muscle.
Diabetes: Can contribute to damage and dysfunction of heart tissues.
Congenital heart defects: Abnormalities in heart structure from birth.
Obesity: Places extra strain on the heart.
Alcohol or drug use: Can cause toxic effects on heart muscle.
Other conditions: Thyroid disorders and persistent arrhythmias are additional risk factors.

Notably, aging itself can contribute to reduced ejection fraction as heart walls thicken and lose efficiency over time.

Treatment for HFrEF

Managing heart failure with reduced ejection fraction usually requires a comprehensive, life-long approach. The goals of treatment include relieving symptoms, improving quality of life, slowing disease progression, and preventing complications.

Medications

Beta blockers: Lower heart rate and blood pressure, ease heart workload, and help improve function.
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs): Help relax blood vessels, lower blood pressure, and have protective effects on the heart muscle.
Diuretics: Help remove excess fluid, reducing swelling and making breathing easier.
Mineralocorticoid receptor antagonists: Help manage persistent symptoms in certain cases.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors: Improve outcomes and decrease mortality rates, regardless of diabetes status.
Other medications: Ivabradine (for lowering heart rate), hydralazine/isosorbide dinitrate (for specific populations), vericiguat (for reducing hospitalization risk).

Lifestyle Adjustments

Diet: Follow a low-sodium, heart-healthy diet; limit fluids if recommended; eat plenty of fruits, vegetables, and whole grains.
Exercise: Engage in moderate aerobic activity, as tolerated, to boost cardiovascular health.
Weight management: Maintain a healthy weight to reduce cardiac load.
Quit smoking: Smoking increases heart disease risk and worsens outcomes.
Limit alcohol intake: Excessive drinking can damage heart tissue.
Monitor symptoms: Track weight, swelling, and fluid retention regularly. Report sudden changes to your doctor.

Surgical and Device Therapies

Implantable cardioverter-defibrillator (ICD): For those with serious arrhythmias or severe left ventricular dysfunction.
Cardiac resynchronization therapy (CRT): Used when the heart’s electrical conduction system is out of sync.
Valve repair or replacement: For cases with significant heart valve damage.
Left ventricular assist device (LVAD): For advanced heart failure not responding to other therapies.
Heart transplant: Considered in select cases when all other treatments have failed.

The choice of therapy depends on severity, underlying cause, and overall health status. All management should be personalized and routinely monitored.

Complications and Prognosis

HFrEF is a serious, progressive condition with significant risks. Complications can vary in severity and impact.

Arrhythmias: Irregular or rapid heartbeats, which can be life-threatening.
Kidney damage: Reduced blood flow to the kidneys may impair their function.
Liver damage: Persistent congestion can harm the liver.
Stroke: Increased risk due to blood clots or low cardiac output.
Sudden cardiac death: Risk increases with severe symptoms and low ejection fraction.

The outlook for people with HFrEF depends on the severity of the condition, response to treatment, and commitment to lifestyle modification. According to recent research:

1-year “all-cause mortality” after HFrEF diagnosis is about 43.69%.
1-year “cardiovascular mortality” is about 21.07%.

Early diagnosis, effective therapy, and ongoing monitoring can improve survival rates and quality of life.

Living with HFrEF: Tips for Everyday Management

Follow medical advice and medication regimen exactly as prescribed.
Maintain regular check-ups with your healthcare team.
Monitor and report new or worsening symptoms promptly.
Participate in cardiac rehabilitation if recommended.
Join support groups or counseling to manage emotional well-being.

Frequently Asked Questions (FAQs)

Q: What is the difference between HFrEF and HFpEF?

A: HFrEF is caused by a weak heart muscle that can’t contract effectively, leading to a low ejection fraction. HFpEF involves a stiff heart muscle that doesn’t relax properly, but the ejection fraction may remain normal.

Q: What tests are used to diagnose HFrEF?

A: Common diagnostic tools include echocardiogram, electrocardiogram (ECG), blood tests for natriuretic peptides, chest X-ray, and advanced imaging (CT, MRI, or nuclear stress test).

Q: Can HFrEF be cured?

A: There is currently no cure for HFrEF, but ongoing treatment can manage symptoms, reduce complications, and enhance quality of life.

Q: How can I improve my heart health with HFrEF?

A: Adhering to medical and lifestyle recommendations, avoiding tobacco, exercising within limits, eating a balanced diet, and managing other health conditions (like diabetes and high blood pressure) are crucial.

Q: Will I need surgery or a device for HFrEF?

A: Many people manage HFrEF with medications and lifestyle changes alone, but surgical or device therapies may be recommended for severe cases or complications.

Summary: Takeaway for Patients

Heart failure with reduced ejection fraction (HFrEF) is a complex, chronic condition requiring lifelong care. Early diagnosis, personalized treatment, healthy lifestyle choices, and ongoing monitoring are key to improving outcomes and living well with HFrEF.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete