ROCKVILLE, MARYLAND (April 22, 2025) - The Heart Failure Society of America (HFSA), the Heart Failure Association of the European Society of Cardiology (HFA of the-ESC), and the Japanese Heart Failure Society (JHFS) announced today a new joint scientific statement titled The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure.
Left ventricular ejection fraction (LVEF) has long served as a central measure in assessing cardiac function and guiding heart failure (HF) management. However, limitations in its diagnostic precision, reproducibility, and relevance across the full spectrum of HF phenotypes have prompted experts to re-evaluate its role. This new statement, developed by an international panel of 21 HF experts through the Trilateral International Consensus Conference (TICC), offers a comprehensive reassessment of the use of LVEF and introduces a dynamic, trajectory-based framework for classifying and managing HF.
The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure statement offers expert consensus and guidance for clinicians on key areas of HF diagnosis and treatment, with a particular focus on:
- Historical context and evolution of LVEF as a measure
- Limitations of current LVEF-based classification systems
- The role of LVEF trajectories in diagnosis, prognosis, and therapy selection
- Emerging imaging techniques and biomarkers for myocardial characterization
- Therapeutic implications across the full spectrum of LVEF, including supra-normal EF
- Future directions in HF stratification and management
Despite widespread reliance on single-point LVEF measurements to define heart failure phenotypes such as HFrEF, HFmrEF, and HFpEF, evidence increasingly shows that these static categories may oversimplify the complex and evolving nature of HF. This joint statement emphasizes a shift toward classification based on LVEF trajectories—such as persistently reduced, worsening, or improved LVEF—which provide more accurate prognostic insights and treatment implications.
“The static categorization of heart failure based on a single LVEF cut-off doesn’t capture the dynamic progression or response to therapy in many patients,” said John Teerlink, MD, FHFSA, co-author and TICC co-chair representing HFSA. “By focusing on LVEF trajectories, clinicians can make more informed treatment decisions and provide more personalized care. Additionally, there are beneficial therapies that can be initiated in patients with heart failure without knowledge of the LVEF.”
The statement also highlights the importance of therapies effective across the full range of LVEF, particularly SGLT2 inhibitors, which demonstrate robust outcomes regardless of EF values, and calls for continued research into novel imaging modalities and myocardial biomarkers that may further refine patient stratification and targeted treatment.
This joint scientific statement was created through the TICC, hosted by the HFA of the-ESC in collaboration with the HFSA and JHFS. Giuseppe Rosano (HFA of the-ESC), John R. Teerlink (HFSA), and Koichiro Kinugawa (JHFS) served as co-chairs. The TICC brings together leaders from global heart failure societies to develop key scientific statements in the field.
The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure will be jointly published on April 22, 2025, at 9:00 AM EDT in the Journal of Cardiac Failure, the official journal of the HFSA and JHFS, and the European Journal of Heart Failure, the official journal of the HFA of the-ESC.
Resource Links
The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure joint scientific statement can be accessed via the link below:
- View online at Journal of Cardiac Failure website: https://onlinejcf.com/article/S1071-9164(25)00153-8/fulltext
- DOI: https://doi.org/10.1016/j.cardfail.2025.03.014
About the Heart Failure Society of America
The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org.
About the Heart Failure Association of the European Society of Cardiology
As the world's largest heart failure association, the Heart Failure Association of the ESC prioritizes patient management and awareness of heart failure as a global health problem. HFA of the-ESC's mission is to improve quality of life and longevity through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research. Learn more online.
About the Japanese Heart Failure Society
In response to the increased interest in heart failure, based on the basic studies on its mechanisms and clinical trials, the Japanese Heart Failure Society (JHFS) was established in 1996. The first General and Scientific Meeting of the JHFS was held in October 1997 at the Kyoto International Conference Center. The number of members increased from 900 to approximately 4000 in 2020. The vision of JHFS is to enrich the happy life of the patients and their families through investigating the basic pathophysiology of heart failure, and developing the effective and efficient diagnosis, prevention and treatment strategies.
About the Journal of Cardiac Failure
The Journal of Cardiac Failure (JCF) publishes the highest quality science in the field of heart failure with a focus on diversity, equity, and inclusion, mentorship, multidisciplinary partnerships, and patient-centeredness. Published papers span original investigator-initiated work to state-of-the-art reviews, guidelines and scientific statements, expert perspectives, early career and trainee spotlight pieces, patient and patient-partner narratives. JCF also emphasizes the power of language and prioritizes innovative approaches to dissemination of published work to reach and impact the broader heart failure community. For more information, visit onlinejcf.com
About the European Journal of Heart Failure
The European Journal of Heart Failure (EJHF) is dedicated to the advancement of knowledge in the field of heart failure management. The journal publishes reviews and editorials to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as clinical, social and population sciences all form part of the discipline. Visit EJHF online.
Media Contact:
Laura Poko: Director of Marketing and Communications, Heart Failure Society of America, 301-798-4493, ext. 226 lpoko@hfsa.org
ESC Press Office: press@escardio.org