Is a cardiac ejection fraction of 47% considered which stage of heart failure?

Heart failure refers to the condition in which the heart is unable to pump blood effectively. Normally, the left ventricular ejection fraction (LVEF) ranges between 55% and 65%. The classification of heart failure severity is based on symptoms; therefore, it is not possible to accurately determine the functional class of heart failure solely from an ejection fraction of 47%. An ejection fraction of 47% is categorized as heart failure with mildly reduced ejection fraction (also known as heart failure with mid-range ejection fraction). A detailed explanation is as follows:

In healthy individuals at rest, the left ventricular ejection fraction typically falls within the range of 55–65%. An ejection fraction below 40% is defined as heart failure with reduced ejection fraction (HFrEF), while an ejection fraction of 50% or higher is classified as heart failure with preserved ejection fraction (HFpEF). When the ejection fraction lies between 40% and 50%, it is termed heart failure with mid-range ejection fraction (HFmrEF). Therefore, an ejection fraction of 46% falls into the category of HFmrEF. It is important to note that ejection fraction categorization and the functional classification of heart failure are two distinct concepts and should not be confused—ejection fraction alone cannot be used to determine the functional class of heart failure.

Typically, patients with Class I heart failure have no limitations on daily activities and do not experience symptoms such as fatigue or shortness of breath during ordinary physical activity. Patients with Class II heart failure experience mild limitations in daily activities; they remain asymptomatic at rest but develop fatigue or dyspnea during routine activities. Patients with Class III heart failure have a marked limitation in their activities; even minimal exertion triggers symptoms like fatigue and shortness of breath. Patients with Class IV heart failure are unable to perform any physical activity without discomfort; symptoms such as fatigue and dyspnea occur even at rest.

In summary, the classification of heart failure involves multiple factors beyond ejection fraction, including symptom severity, exercise tolerance, and clinical presentation. Therefore, if symptoms suggestive of heart failure are present, it is best to consult a physician for a comprehensive evaluation and accurate diagnosis.