In a bold stride toward revolutionizing cardiovascular care, the American Heart Association (AHA) has unveiled a groundbreaking initiative aimed squarely at improving treatment for heart failure patients with preserved and mildly reduced ejection fraction (HFpEF and HFmrEF). These subtypes of heart failure represent a paradigm shift in cardiac disease management, accounting for nearly three-quarters of all heart failure cases. Despite their prevalence, clinical research and therapeutic options remain disproportionately scarce compared to heart failure with reduced ejection fraction (HFrEF), leaving a critical gap in patient care that this new program intends to bridge.
Heart failure with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF) present distinct pathophysiological challenges. Unlike traditional heart failure where the heart’s pumping capacity is markedly diminished, HFpEF patients maintain an ejection fraction above 50%. Here, the cardiac muscle contracts adequately but exhibits impaired relaxation during diastole, leading to inefficient ventricular filling. HFmrEF, characterized by ejection fractions between 41% and 49%, occupies a nuanced space between preserved and reduced function, with clinical profiles and treatment implications that are only recently being elucidated through emerging research.
The AHA’s new three-year quality improvement initiative, named IMPLEMENT-EF, seeks to systematically dissect and address these complexities. By mapping deficiencies in the patient journey and care delivery models, the initiative strives to delineate optimal management strategies and foster consistent application of evidence-based therapies. Using robust data obtained from the AHA’s Get With The Guidelines® – Heart Failure registry, it will leverage real-world clinical insights to refine treatment paradigms and disseminate best practices across care settings nationwide.
Central to the initiative is the mobilization of multidisciplinary care teams. Recognizing that effective management of HFpEF and HFmrEF transcends conventional cardiology, the program incorporates pharmacists, nurses, and allied health professionals as integral collaborators. This team-based approach emphasizes early identification of at-risk individuals, prompt initiation of scientific, protocol-driven treatments, and ongoing patient support to ensure adherence and optimal health outcomes.
Ejection fraction, the clinical metric pivotal to this initiative, quantifies the proportion of blood ejected from the left ventricle per heartbeat. Normal EF ranges from 55% to 70%, serving as a benchmark for cardiac performance. In patients with HFpEF, the heart’s impaired relaxation compromises ventricular filling without undermining contraction strength, posing diagnostic and therapeutic conundrums. Conversely, HFmrEF reflects a mildly diminished pump function, linking pathophysiology more closely to traditionally studied heart failure phenotypes, but still demanding tailored treatment strategies.
Pharmacological treatment innovations for HFpEF and HFmrEF are burgeoning but remain underutilized. The initiative aims to expedite translation of cutting-edge therapies—including novel agents such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists—into clinical practice by educating providers and fostering rigorous treatment adherence. This effort is anticipated to mitigate morbidity and improve quality of life for millions grappling with these heart failure subtypes.
One of the distinctive features of IMPLEMENT-EF is its emphasis on education and knowledge dissemination. The initiative will deploy an array of professional learning modalities, from interactive eLearning modules and live expert presentations to an innovative podcast series featuring thought leaders in cardiology. These resources are designed to elevate provider competence and confidence, thereby enhancing clinical decision-making and patient management efficacy.
Supporting the educational framework, a dedicated Science Advisory Panel of renowned experts will oversee content development and ensure the integrity and currency of the materials. This panel’s guidance guarantees that frontline clinicians receive the most authoritative and up-to-date information, facilitating the adoption of evidence-based interventions throughout diverse healthcare environments.
Underpinning this ambitious endeavor is collaborative synergy with Bayer, whose support enables the recruitment of 40 hospitals to participate in the program’s inaugural phase. These sites will serve as hubs for knowledge exchange, peer collaboration, and pilot testing of quality improvement models. This experiential learning environment fosters innovation and facilitates scaling of successful interventions to broader healthcare systems, maximizing the initiative’s impact.
The urgency of addressing HFpEF and HFmrEF cannot be overstated. Unlike HFrEF, where decades of research have propelled treatment advances, the lingering knowledge gaps in these subtypes have contributed to stagnant outcomes. IMPLEMENT-EF aims to catalyze progress by infusing data-driven strategies, multidisciplinary cooperation, and targeted education into everyday care delivery, ultimately transforming the prognosis for millions afflicted by these insidious forms of heart failure.
Dr. Mariell Jessup, chief science and medical officer at the AHA, encapsulated the initiative’s vision by emphasizing the necessity of a coordinated, team-based approach. She highlighted how integrating diverse expertise and leveraging real-world data will not only elevate care quality but also forge scalable, replicable models that can be disseminated nationally to benefit broad patient populations.
Similarly, Robert Perkins, vice president of U.S. medical affairs for cardiovascular and renal at Bayer, expressed corporate commitment to advancing translational science in cardiovascular medicine. His remarks underscored the partnership’s shared goal of bridging gaps in evidence and expanding access to innovative, effective treatments for HFpEF and HFmrEF patients.
As this initiative unfolds, the medical community and patients alike are encouraged to stay informed through the AHA’s dedicated portal, HEART.org/IMPLEMENTEF. This resource will provide ongoing updates, insights, and tools emanating from the program’s unfolding progress, fostering transparency and community engagement in this vital quest to reshape heart failure care.
In sum, the American Heart Association’s IMPLEMENT-EF initiative represents a crucial advancement in addressing the unmet needs of heart failure patients with preserved and mildly reduced ejection fractions. By uniting data analytics, multidisciplinary collaboration, and professional education under one ambitious umbrella, the program promises to chart a new course toward improved survival, reduced symptoms, and enhanced quality of life for millions confronting these complex cardiac conditions.
Subject of Research: Heart failure with preserved and mildly reduced ejection fraction (HFpEF and HFmrEF) treatment and care improvement.
Article Title: American Heart Association Launches IMPLEMENT-EF, an Innovative Initiative to Transform Care for HFpEF and HFmrEF Patients.
News Publication Date: September 15, 2025.
Web References:
https://www.heart.org/en/professional/quality-improvement/IMPLEMENT-EF
https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure
https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure
References:
Savarese G, Stolfo D, Sinagra G, Lund L. Heart failure with mid-range or mildly reduced ejection fraction. Nat Rev Cardiol. 2022;19:100–116.
Shah S, Kitzman D, et al. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap. Circulation. 2016;134(1).
Shah K, Xu H, Matsouaka R, et al. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. JACC. 2017 Nov;70(20):2476–2486.
Kapelios CJ, Shahim B, Lund LH, Savarese G. Epidemiology, Clinical Characteristics and Cause-specific Outcomes in Heart Failure with Preserved Ejection Fraction. Cardiac Failure Review. 2023;9:e14.
Keywords: Heart Failure, HFpEF, HFmrEF, Ejection Fraction, Cardiovascular Care, Multidisciplinary Teams, Quality Improvement, Evidence-Based Therapies, Patient Outcomes, American Heart Association, IMPLEMENT-EF, Pharmacological Therapy.
Tags: AHA quality improvement initiativecardiovascular care innovationsclinical challenges in heart failurediastolic dysfunction treatmentejection fraction classificationemerging heart failure therapiesheart disease management advancementsheart failure patient care gapsheart failure treatmentheart failure with preserved ejection fractionHFmrEF clinical researchHFpEF management strategies
