CHF patients are divided into two main groups: those with reduced ejection fraction (HFrEF) and those with preserved EF (HFpEF) as defined by the measurement of left ventricular ejection fraction (LVEF), the central measure of left ventricular systolic function. The LVEF cutoff has varied over time, but AHA/ACC/HFSA and ESC guidelines now utilize ≤40% for HFrEF and ≥50% for HFpEF, with a third group in the middle having mildly reduced EF (HFmrEF). Despite similar symptoms and disabilities, HFrEF and HFpEF appear to have features of distinct syndromes, with differing epidemiology, LV morphology, and cellular changes, though some have challenged this view. 

Owing to the links between obesity and more serious HFpEF, the prescription weight loss agents semaglutide and tirzepatide could be quite useful for these patients. Semaglutide has already shown improvements in symptoms, physical limitations, and exercise function linked to degree of weight loss, although further analyses of hard endpoints in larger trials are needed to get a better understanding of cardiac benefit. Success could additionally help reimbursement in obese HFpEF patients, since coverage for the treatment of obesity itself is not universal. 

This Datamonitor Healthcare report contains a Disease Analysis module.