Reconsidering the ejection fraction centric view of pharmacologic treatment for heart failure

For the past two decades, heart failure (HF) has been classified into two phenotypes based on ejection fraction (EF). Inhibitors of the RAAS, neprilysin and beta‐blockers represent foundational treatments for patients with a reduced EF (<40%) but have not been considered effective in patients with preserved EF (≥40%). However, re‐examination of the clinical trial evidence has cast considerable doubt about the utility of an EF threshold of 40% as the main decision tool for HF treatment. In CHARM, candesartan reduced the risk of cardiovascular death or HF hospitalization by 24% up to an EF of 50%, with attenuation of the effect on HF hospitalization in patients...