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Isolation of Atrial Cardiomyocytes from a Rat Model of Metabolic Syndrome-related Heart Failure with Preserved Ejection Fraction
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Canadian Cardiovascular Society/Canadian Heart Failure Society 2025 Guideline Update for Pharmacologic Management of

Sean Virani1, Shelley Zieroth2, Natasha Aleksova3

  • 1University of British Columbia, Vancouver, British Columbia, Canada.

The Canadian Journal of Cardiology
|October 19, 2025
PubMed

Insights

Heart failure with nonreduced ejection fraction (HFnrEF) is increasingly common. New guidelines unify treatment for HFnrEF patients with LVEF > 40%, recommending key medications to improve outcomes and reduce hospitalizations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Guidelines

Background:

  • Heart failure with nonreduced ejection fraction (HFnrEF), characterized by left ventricular ejection fraction (LVEF) > 40%, is a growing clinical concern.
  • Historically, this patient group was divided into HF with mildly reduced (HFmrEF) or HF with preserved ejection fraction (HFpEF), leading to potential ambiguity in care.
  • Emerging evidence suggests consistent clinical outcomes and treatment responses across the LVEF > 40% spectrum.

Purpose of the Study:

  • To provide a unified clinical framework and guideline for the pharmacological management of symptomatic HFnrEF.
  • To reduce ambiguity in decision-making and promote consistent application of evidence-based therapies for HFnrEF.
  • To support clinicians in translating evidence into practice for improved patient well-being.

Main Methods:

  • Development of guideline recommendations based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
  • Inclusion of meta-analyses focusing on pharmacotherapies proven to reduce HF hospitalization (HFH) and enhance patient well-being.
  • Focus on four key classes of pharmacological therapies: SGLT2 inhibitors (SGLT2i), MRAs, ARNIs, and GLP-1 receptor agonists.

Main Results:

  • The guideline offers concise recommendations for the pharmacological treatment of HFnrEF.
  • Practical tips are provided for initiating, titrating, and maintaining foundational treatments.
  • Emphasis is placed on therapeutic consistency across the LVEF > 40% spectrum.

Conclusions:

  • Adoption of the term HFnrEF simplifies clinical decision-making and promotes standardized care.
  • Consistent application of guideline-directed medical therapy across the HFnrEF spectrum can streamline care pathways.
  • This guideline aims to enhance the delivery of effective medical therapy for symptomatic HFnrEF in real-world settings.

Keywords:
Canadian Cardiovascular Societyguidelineheart failure

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