Types of Heart Failure

Your heart is a pump. It moves blood and oxygen-rich nutrients through your body. If you have heart failure, your heart may not be pumping or relaxing as well as it should. As a result, fluid can build up in the body – often in the legs, belly and lungs.

This also means your heart has difficulty pumping enough blood to meet your body's needs for blood and oxygen. It's no wonder then that if you have heart failure, you may tire more easily and feel short of breath.

There are four main types of heart failure based, in part, on your ejection fraction (EF) – a measure of how much blood your heart pumps out with each beat. 

Understanding which type of heart failure you have will help your care team recommend the best course of treatment. You may move between heart failure types and stages if your condition improves or gets worse. That’s why close monitoring, reporting of symptoms and carefully following your treatment plan is important. 

• Heart failure with reduced ejection fraction (HFrEF) – EF of 40% of lower. With HFrEF, the heart muscle is too weak to pump blood to the rest of the body with enough force. Treatment usually includes medicines from four key classes that work together to help the heart work more efficiently and improve survival.
• Heart failure with improved ejection fraction (HFimpEF) – EF had been lower than 40% at some point, but on follow-up testing, improved to greater than 40%. Even if your EF improves, you should continue to take the medicines your care team recommends.
• Heart failure with mildly reduced ejection fraction (HFmrEF) – EF between 41% and 49%. The heart’s pumping ability is slightly below normal. Treatment may include some of the same medications used for HFrEF.
• Heart failure with preserved ejection fraction (HFpEF) – EF of 50% or higher. With HFpEF, the heart’s ability to squeeze and pump blood is normal (“preserved). But the heart can’t fill with enough blood because it has a hard time relaxing and may be stiff. As a result, less blood full of oxygen and nutrients is pumped out to your body.
  
  With HFpEF, the pressure inside the heart also increases. This can make you feel short of breath and can push fluid into places it shouldn't be (for example, your lungs, belly, or legs). Medications can help reduce your risk of being hospitalized with heart failure and improve survival.  Managing other conditions like blood pressure, blood sugar and weight is especially important, as problems with these conditions can make HFpEF worse.

Stages of Heart Failure

In addition to the type of heart failure you have, your care team may also talk with you about the “stage” of your heart failure. Heart failure generally gets worse with time. There are four stages of heart failure – Stages A, B, C and D.