Why the study?
Heart failure is traditionally classified by arbitrary LVEF cutpoints, but therapies show benefits across a wide range of LVEF, suggesting the standard categorization paradigm merits modification.
The Heart Failure Collaboratory advocates challenging current multi-tier LVEF guidelines by eliminating the HFmrEF and HFimpEF categories in favor of a simplified binary classification (reduced vs. non-reduced LVEF) to better reflect therapeutic responsiveness.
Heart failure (HF) is a complex syndrome traditionally classified by left ventricular ejection fraction (LVEF) cutpoints. Although LVEF is prognostic for risk of events and predictive of response to some HF therapies, LVEF is a continuous variable and cutpoints are arbitrary, often based on historical clinical trial enrichment decisions rather than physiology. Holistic evaluation of the treatment effects for therapies throughout the LVEF range suggests the standard categorization paradigm for HF merits modification. The multidisciplinary Heart Failure Collaboratory reviewed data from large-scale HF clinical trials and found that many HF therapies have demonstrated therapeutic benefit across a large range of LVEF, but specific treatment effects vary across that range. Therefore, HF should practically be classified by association with an LVEF that is reduced or not reduced, while acknowledging uncertainty around the precise LVEF cutpoint, and future research should evaluate new therapies across the continuum of LVEF.
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Dimond et al. (2023) conducted a review in Heart failure. Left ventricular ejection fraction (LVEF) categorization was evaluated.
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