IJCS | Volume 33, Nº1, January / February 2019

44 of the study that patients who presented themselves as HFmrEF now resemble each other’s extremes. They resemble HFrEF in NYHA functional class, etiologies, chronic kidney disease, valvular heart disease, alcoholism and smoking, prevalence of atrial fibrillation, mitral and tricuspid regurgitation, and B-type natriuretic peptide levels. On the other hand, they resemble HFpEF as to age, presence of hypertension and diabetes mellitus, anemia and right ventricular remodeling. Mortality appears to be closer to HFpEF and 30-day readmission to HFrEF. These last two facts lose magnitude, since all numbers are alarming. Cavalcanti et al., 7 presented a frequency of 26% of patients with HFmrEF, as well as other characteristics consistentwith those recentlydescribed in the literature. 6,8,9 It is very important that we know this characterization, because the answer on how to treat depends on it. The HFrEF prescription, very well grounded in large clinical trials or the therapeutic uncertainties of HFpEF. Cavalcanti et al., 7 show data that should reflect the reality of a tertiary or quaternary referral hospital in a populationwith a higher socioeconomic level. We should contextualize this. It may not be reproduced in primary care or in public institutions. The still very high 30-day mortality and readmission rates presented by Cavalcanti et al., 7 make it mandatory that we improve the approach to HF as a whole, independent of LVEF. It is important to have the demographic and clinical portrait of HFpEF andHFmrEF. The paper presented by Cavalcanti et al., 7 is an important contribution to one of the obscure areas of HF. We do hope that the debate at the Hyde Park session should be based on evidence such as the one presented by Cavalcanti et al. 7 1. Heart Failure Society of America.(HFSA). [Internet]. [Cited in 2019 Oct 11]. Available from: https://meeting.hfsa.org/past-meetings/ 2. Pfeffer MA, ShahAM, Borlaug BA. Heart failure with preserved ejection fraction in perspective. Circ Res. 2019;124(11):1598-617. 3. Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344(1):17-22. 4. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62(16):e147-239. 5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS., et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(36):2129-200. 6. Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T., et al. Characterization of heart failure patients with midrange left ventricular ejection fraction-a report from the CHART-2 study. Eur J Heart Fail. 2017;19(10):1258-69. 7. Cavalcanti CP, Sarteschi C, Gomes GES, Medeiros CA, Pimentel JHM, Lafayette AR, et al. Decompensated heart failure with mid-range ejection fraction: epidemiology and inhospital mortality risk factors. Int J Cardiovasc Sci. 2020;33(1):45-54. 8. Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, et al. Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. J Am Coll Cardiol HF. 2016;4(6):464-72. 9. Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: A systematic review and meta-analysis. ESC Heart Fail. 2018;5(4):685-94. References Martins & Jorge The ejection fraction returns to Hyde Park Int J Cardiovasc Sci. 2020;33(1):43-44 Editorial This is an open-access article distributed under the terms of the Creative Commons Attribution License