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The authors of the 2016 European Society of Cardiology (ESC) guidelines on the diagnosis and treatment of acute and chronic heart failure described a new term to categorise patients with a resting left ventricular ejection fraction (LVEF) in the range of 40 − 49%, so‐called heart failure with mid‐range ejection fraction (HFmrEF), formerly referred to as ‘grey‐area’ ejection fraction in the previous iteration of the guidelines.1, 2 This designation overlapped with the previously described heart failure with preserved ejection fraction (HFpEF), which had included patients with a LVEF > 40% in one clinical trial but, more generally, patients with a LVEF > 45%.3-6 Puzzlingly, the 2016 guideline authors continued to use the description HFpEF for patients with a LVEF ≥ 50%. This change in terminology has caused understandable confusion and should be replaced.


Mary MacKillop Institute for Health Research

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Journal Article

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