Jeffery Northway, MS; Farzana Hoque, MD
WMJ. 2025;124(5):452-459.
ABSTRACT
Heart failure is a growing global health concern, characterized by high morbidity, frequent hospitalizations, and significant mortality. The classification of heart failure based on left ventricular ejection fraction plays a critical role in diagnosis and management, encompassing heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with improved ejection fraction (HFimpEF). While advancements in therapy have transformed HFrEF management, challenges persist in optimizing treatment for HFmrEF and HFimpEF due to their heterogeneous nature. Emerging strategies emphasize the early and simultaneous initiation of key pharmacologic therapies across these subtypes to maximize clinical benefits. Individual approaches, guided by patient characteristics and evolving evidence, are essential for improving outcomes. This narrative review provides a comprehensive overview of current treatment strategies for the different classifications of HF, highlighting the role of rapid therapy initiation.