a diagram of a heart showing blood pumping in and out of the blood vessels

Living With Heart Failure: Reduced Ejection Fraction vs. Preserved Ejection Fraction

Last updated: February 2024

Millions of people around the world have been diagnosed with heart failure. While many people with the condition experience similar symptoms, heart failure can be classified in several different ways.

We conducted our 2020 Heart Failure In America survey to learn more about heart failure and the way it impacts those with the diagnosis. More than 600 men and women with heart failure completed the survey and provided a unique look at the condition.

The role of ejection fraction

One common way to classify heart failure is based on ejection fraction. The amount of blood pumped out of the heart with each beat is called the ejection fraction (EF). A normal EF is usually around 55 to 70 percent, but it can be lessened in some forms of heart failure.1

People with heart failure with reduced ejection fraction (HFrEF) have an EF that is 40 to 50 percent or lower. This is also called systolic heart failure. People with heart failure with preserved ejection fraction (HFpEF) do not have much of a change in their ejection fraction. This is often called diastolic heart failure.1

Differences in symptoms and diagnosis

Survey responses show many differences in symptoms and diagnoses between people with HFrEF and HFpEF.

Survey respondents with HFrEF were often diagnosed earlier in life and right after a heart attack. Many of these survey respondents shared that they are unsure about the current stage of their diagnosis.

In contrast, survey respondents with HFpEF were diagnosed later in life and first experienced symptoms of heart failure between the ages of 65 and 69. Many of those with HFpEF also shared that they have other health problems that led to their diagnosis. Many of them also live with additional health conditions, including acid reflux (GERD), high blood pressure, kidney disease, and sleep disorders.

Survey respondents with HFpEF were more likely to be diagnosed with and still have stage C heart failure with mild or moderate symptoms.

Contrasts in quality of life

Men and women who completed the survey experience differences in quality of life depending on their ejection fraction.

Many of those with HFrEF shared that they feel depressed and/or anxious about their heart failure diagnosis. Risk factors for those in this group include genetics or a family history of heart failure.

A number of survey respondents with HFpEF shared that they are still able to do the things they enjoyed before their heart failure diagnosis. Survey respondents in this group shared that they also have more heart failure risk factors, including:

  • Sedentary lifestyle
  • High blood pressure
  • Sleep apnea
  • Other heart conditions

Treatment and symptom management of each

When it comes to treatment options, survey responses show some trends between HFrEF and HFpEF heart failure.

Survey respondents with HFrEF are more likely to have had surgery, including surgery to implant a pacemaker or other heart rhythm control device. In contrast, most respondents with HFpEF have never had surgery to treat their heart failure or had a device implanted.

Many of those with HFrEF shared that they currently use combination therapy to treat their heart failure. However, most respondents with HFpEF shared that the cost of medication/treatment is the most important factor in their treatment plan decision.

Overall, the majority of respondents with HFpEF said they were satisfied with the care they received from their doctor or healthcare team. Many of these healthcare professionals were affiliated with an academic medical center. These are facilities associated with a university or teaching hospital system.

Gender differences in demographics and lifestyle

Interestingly, survey responses show gender differences in HFrEF and HFpEF diagnoses. Most survey respondents with HFrEF are men who live in rural areas. However, most respondents with HFpEF are women who live in urban areas.

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