Heart failure with reduced ejection fraction (HFrEF) describes a type of heart failure in which the heart loses its ability to contract typically. Because of this, the heart cannot pump with enough force to push enough blood into circulation.

The heart is a muscular pump that circulates blood throughout the body. It is essential to maintain heart health and help prevent any heart disease that may stop the heart from functioning correctly.

Heart failure refers to when the heart cannot effectively pump blood around the body. When this occurs due to the heart muscle not contracting effectively, a medical professional may refer to it as HFrEF.

In this article, we discuss HFrEF, including what ejection fraction (EF) is, and treatment options for heart failure.

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Heart failure, also known as congestive heart failure, describes a condition in which the heart cannot pump enough blood around the body.

The pumping action of the heart moves oxygen-rich blood from the lungs to the left atrium of the heart, then on to the heart’s left ventricle, which pumps it to the rest of the body. When there is a problem with the left side of the heart’s ability to pump blood, doctors call it left-sided heart failure.

There are two types of left-sided heart failure, which differ in EF. This refers to how much blood the heart pumps out during a contraction.

Medical professionals express EF as a percentage (%). For example, an EF of 60% indicates that 60% of the total amount of blood in the left ventricle leaves the heart with each heartbeat.

A typical EF measurement may be between 50–70%. Healthcare professionals describe HFrEF, also known as systolic heart failure, as heart failure with an EF measurement of 40% or below. It occurs when the heart muscle does not contract effectively, meaning the heart pumps out less oxygen-rich blood to the body.

Evidence suggests roughly 23 million people experience heart failure, and approximately half of cases are HFrEF.

The other type of left-sided heart failure is known as heart failure with preserved ejection fraction (HFpEF). Healthcare professionals may also refer to it as diastolic failure.

While HFrEF describes heart failure that occurs with a low EF measurement, HFpEF refers to heart failure with an EF measurement of 50% or higher.

With HFpEF, the left ventricle loses its ability to relax as it should due to it becoming stiff. This stiffness means the heart cannot fill with sufficient blood during the resting period between each heartbeat.

Many factors may contribute to the development of heart failure. It can occur suddenly or may progress slowly over months or years. The most common causes of heart failure include:

Other possible causes can include:

Risk factors for developing heart failure can include:

Common symptoms of heart failure may include:

To help measure a person’s EF, a doctor may recommend one or more of the following tests:

  • Echocardiogram: This test uses ultrasound to take pictures of the heart. It allows medical professionals to look at the structures of the heart and assess its functioning.
  • Multiple-gated acquisition scan: This is a type of nuclear imaging test. It uses a radioactive tracer and a special camera to take pictures of the heart as it pumps blood.
  • CT scan: This noninvasive imaging test combines data from several X-rays to help produce a detailed image of the heart.
  • Cardiac catheterization: This imaging procedure involves placing a catheter into a large blood vessel that leads to the heart. It helps healthcare professionals to assess whether a person’s heart is working effectively.
  • Nuclear stress test: This imaging test uses a small amount of a radioactive substance to examine a person’s blood flow during rest and activity.

A variety of treatment options for HFrEF exist. They can include:


Medications a medical professional may consider for treating HFrEF include:

A doctor may try to avoid prescribing some medications as they may be harmful to certain individuals with heart failure. These can include nonsteroidal anti-inflammatory drugs, calcium channel blockers, and thiazolidinediones.

Devices and nonsurgical interventions

These options may include an implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT).

An ICD is a battery-powered device that tracks a person’s heart rate. If it detects an abnormal heart rhythm, the device delivers an electric shock to restore a typical rhythm.

A CRT is a pacemaker that also monitors heart rate. If it detects any irregularities, it emits a tiny pulse of electricity to resynchronize the heart.

A doctor will typically recommend these options if a person’s condition has not shown signs of improvement after 3 months of pharmacological therapy.

Surgery and invasive therapies

In more severe cases, a doctor may consider surgical options. This may include:

HFrEF, also known as systolic failure, is a type of left-sided heart failure. It occurs when the left ventricle cannot contract as it should, so it cannot pump with enough force to push sufficient blood into circulation.

EF describes how much blood the heart pumps out during a contraction. As such, HFrEF refers to the heart pushing out a reduced amount of blood with each heartbeat.

A number of treatment options exist for HFrEF, and can include medications, implantable devices, and surgical treatments.