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Heart Failure Update: Clarifying New Terminology

October 6, 2020

By now all of us should be familiar with the terminology and coding for heart failure with reduced ejection fraction (HFrEF), which is properly indexed to systolic heart failure, whereas heart failure with preserved ejection fraction (HFpEF) is properly indexed to diastolic heart failure.  The most up to date clinical definition of systolic heart failure is an ejection fraction < 50% and, in diastolic heart failure, the ejection fraction >= 50%.

A new term has been recently introduced: heart failure with “mid-range” ejection fraction (HFmrEF) defined as EF is 41– 49%. Those who employ the term HFmrEF consider systolic failure to be EF <41%. The clinical significance of the mid-range EF compared with EF reduced below 41% are yet unknown. Coding Clinic 2020 Third Quarter, p. 32, advises to code chronic systolic heart failure for patients with heart failure described with reduced, mildly reduced, or mid-range ejection fraction. This makes perfect sense because systolic failure is recognized as EF < 50%.

Yet another new term has recently been proposed: heart failure with recovered ejection fraction (HFrecEF) which is intended to describe a significant improvement in a reduced EF (systolic heart failure) usually following aortic valve replacement such as TAVR. Coding Clinic 2020 Third Quarter, p. 32, also advises to code chronic diastolic heart failure for patients with a “recovered” EF that is above 50%. It does not address what to do about “recovery” to an EF < 50%, which is clinically systolic failure. If the EF does not recover to normal, a query may be necessary to determine if the recovered EF represents systolic or diastolic failure.

In summary:

  • HFrEF (<50%) is systolic, HFpEF (>= 50%) is diastolic.
  • A new term, HFmrEF, has been introduced when the EF is 41-49 and coded as systolic failure.
  • HFrecEF describes a significant improvement in a reduced EF usually following TAVR. If recovered to >=50% it is coded as diastolic; if <50% it ought to constitute improved, but persistent, systolic failure.

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