The HFREF medical abbreviation stands for heart failure with reduced ejection fraction, a type of heart failure in which the main pumping chamber, the left ventricle, squeezes out less blood than normal with each beat. It is usually written HFrEF, with a small r, though some records print it in all capitals.
You may see it on an echocardiogram report, a cardiology clinic note or a hospital discharge summary. It is one of the subtypes that sit under the broad label of CHF, and it is the counterpart of HFpEF, where the squeeze is preserved. This page walks through the number that defines it, the related labels, and how the term reads in a real chart.
At a glance
Stands for
Heart failure with reduced ejection fractionWritten as
HFrEF, HFREF, HFrEFDefining number
Left ventricular ejection fraction of about 40% or lowerOlder name
Systolic heart failureDo not confuse with
HFpEF, preserved ejection fractionSpecialty
Cardiology, internal medicine, hospital medicineWhere you see it
Echo reports, problem lists, discharge summaries
What the HFREF medical abbreviation describes
Ejection fraction, or EF, is the share of blood in the left ventricle that is pushed out with each heartbeat. A healthy heart usually ejects a little over half. In HFrEF the muscle is weakened or stretched, so the fraction falls, and the body may not get as much blood as it needs during activity or even at rest.
People with this condition may notice shortness of breath, tiredness, swelling in the legs or ankles, or needing extra pillows to breathe at night. The label itself does not describe how severe symptoms are. Cardiologists use separate scales for that, and the EF is just one piece of the assessment.
The ejection fraction ranges behind the label
Heart failure is now sorted mainly by the EF measured on an echocardiogram or another heart scan. Cutoffs can differ slightly between guidelines and hospitals, but the common grouping looks like this.
| Label | Full name | Usual EF |
|---|---|---|
| HFrEF | Reduced ejection fraction | About 40% or less |
| HFmrEF | Mildly reduced ejection fraction | About 41% to 49% |
| HFpEF | Preserved ejection fraction | About 50% or more |
| HFimpEF | Improved ejection fraction | Was 40% or less, later above 40% |
A person can move between groups over time as treatment works or as the heart changes, which is why a recent echo report matters when reading older notes.
Decoding a cardiology note line
Here is a typical line from a follow up visit, broken into its parts.
Clinic note: "HFrEF, LVEF 30% on TTE, NYHA class II, on GDMT, euvolemic today." This says the patient has heart failure with reduced ejection fraction, the last transthoracic echo showed an EF of 30%, symptoms appear with ordinary activity, the patient takes the standard set of heart failure medicines, and there is no sign of fluid overload at this visit.
LVEF means left ventricular ejection fraction. NYHA refers to the New York Heart Association functional classes, which run from I for no limits to IV for symptoms at rest. GDMT is guideline directed medical therapy.
Common causes and how it is treated
Coronary artery disease and past heart attacks are frequent causes, because damaged muscle pumps less well. Long standing high blood pressure, valve disease, viral infection of the heart, heavy alcohol use, some cancer treatments and inherited heart muscle diseases can also lead to it. When the cause is not blocked arteries, notes may say nonischemic cardiomyopathy.
HFrEF has a strong base of research behind its medicines. Treatment plans commonly include four groups of drugs: an ARNI such as sacubitril with valsartan, or an ACE inhibitor or ARB; a beta blocker such as carvedilol or metoprolol succinate; a mineralocorticoid receptor antagonist such as spironolactone; and an SGLT2 inhibitor such as dapagliflozin or empagliflozin. Diuretics such as furosemide ease fluid buildup. Some patients also receive an implanted defibrillator or a pacing device that coordinates the two ventricles. Which of these suit a given person is a decision for the care team.
HFrEF compared with similar heart terms
Several abbreviations near this one describe related but different things. CHF is the older umbrella term for heart failure of any type. Systolic dysfunction describes the weak squeeze itself and is often used as a near synonym. Cardiomyopathy refers to disease of the heart muscle, which may or may not cause heart failure. CAD, coronary artery disease, is a common cause rather than a type. To compare HFrEF with other heart and lung labels, browse the diagnosis abbreviations collection.
Things to ask at a heart failure appointment
If your own report says HFrEF, you might bring this short list along.
- What was my most recent ejection fraction, and when was it measured?
- What is thought to be the cause in my case?
- Which of my medicines are for heart failure, and what does each one do?
- Should I weigh myself daily, and what change should prompt a call?
- Is a repeat echo planned to see whether my EF has changed?
The ejection fraction ranges here are general reference points. Your cardiologist or heart failure nurse can explain what your own numbers and treatment plan mean.
Frequently asked questions
What is the full form of HFrEF?
Heart failure with reduced ejection fraction. The heart's main pumping chamber pushes out a smaller share of its blood than normal, usually about 40% or less, with each beat.
Is HFrEF the same as systolic heart failure?
Mostly yes. Systolic heart failure is the older name for the same idea, a weak squeeze of the left ventricle. Current guidelines prefer labels based on the measured ejection fraction.
What is the difference between HFrEF and HFpEF?
In HFrEF the ejection fraction is reduced, usually about 40% or lower. In HFpEF it stays about 50% or higher, but the heart is stiff and does not fill well, so symptoms can look similar.
Can the ejection fraction improve with HFrEF?
It can for some people, especially with treatment or when the cause can be addressed. When an EF that was 40% or lower rises above 40%, notes may switch to the label HFimpEF, heart failure with improved ejection fraction.
How is the HFrEF medical acronym pronounced?
Many clinicians say H-F-ref, blending the last part into one syllable. Others spell out all five letters. Both are understood.