Ejection Fraction (EF) is a measurement that quantifies the efficiency of the heart’s pumping action. It represents the percentage of blood that the left ventricle, the heart’s main pumping chamber, pushes out to the body with each beat. A normal Ejection Fraction typically falls between 55% and 70%. When this percentage drops, it indicates that the heart is not circulating enough blood to meet the body’s needs, a condition known as heart failure with reduced ejection fraction. Improving a low EF is achievable through a comprehensive and structured management plan that incorporates pharmacological, behavioral, and, when necessary, advanced procedural interventions.
Cornerstone Drug Therapies
The foundation for improving a reduced Ejection Fraction rests on medications that promote “reverse remodeling,” helping the heart muscle regain efficient shape and function. These pharmacological agents work together to counteract the harmful hormonal and nervous system responses that become overactive when the heart is weakened. Contemporary guidelines recommend the systematic use of four distinct drug classes, often referred to as Guideline-Directed Medical Therapy, to achieve the most significant and lasting improvements in cardiac function.
One primary strategy involves blocking the Renin-Angiotensin-Aldosterone System (RAAS), a hormonal pathway that constricts blood vessels and causes salt and water retention, increasing the heart’s workload. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) are now often preferred over older Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin II Receptor Blockers (ARBs). This preference is due to ARNIs providing a superior benefit in reducing mortality and heart failure hospitalizations. These medications widen blood vessels, lowering blood pressure and making it easier for the heart to pump blood forward against less resistance.
Beta-blockers constitute the second major class, functioning by slowing the heart rate and reducing the force of contraction. This action protects the heart muscle from the damaging effects of chronic overstimulation by stress hormones like adrenaline. Over time, this protective effect allows the heart muscle to recover and restructure, leading to measurable increases in the Ejection Fraction. Specific beta-blockers, such as carvedilol and metoprolol extended-release, have been proven effective in clinical trials to improve survival and symptoms.
Mineralocorticoid Receptor Antagonists (MRAs), such as spironolactone, form the third group and work by blocking the effects of the hormone aldosterone. Aldosterone contributes to fluid retention and causes harmful scarring, or fibrosis, in the heart muscle. By inhibiting aldosterone, MRAs help reduce fluid buildup and lessen the remodeling that stiffens the heart, further supporting the heart’s capacity to pump effectively. They are typically added to the regimen once a patient is stable on a RAAS inhibitor and a beta-blocker.
The fourth and most recently adopted class is the Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors, which were initially developed for diabetes management. These agents have demonstrated a profound benefit in heart failure, regardless of whether the patient has diabetes. The exact mechanism of their cardiac benefit is complex, but they improve cardiac energy use, reduce inflammation, and promote the excretion of excess fluid and sodium through the kidneys. The systematic use of all four drug classes, titrated to the highest tolerated dose, is estimated to significantly lower the risk of death and hospitalization compared to using fewer agents.
Lifestyle Changes That Support Heart Strength
While medication addresses underlying physiology, daily habits are equally important for supporting cardiac function and preventing strain. Modifying dietary intake is one of the most immediate and impactful changes necessary for managing a reduced Ejection Fraction. Restricting sodium intake is paramount because excessive salt causes the body to retain water, leading to increased blood volume and fluid congestion that severely stresses the heart.
Physicians often recommend limiting daily sodium consumption to 1,500 milligrams or less, which is substantially lower than the typical Western diet. This requires diligent label reading and avoiding most processed and restaurant foods. Furthermore, managing fluid intake is often necessary to prevent volume overload, and doctors may set a specific daily fluid limit based on the degree of heart function impairment. Consistent daily weighing is also a simple behavioral measure that helps a person monitor for sudden fluid retention, which can be an early sign of a worsening condition.
Incorporating regular, structured physical activity is also a powerful intervention that helps strengthen the heart and improve overall capacity. Supervised exercise programs, such as Cardiac Rehabilitation, are highly recommended because they provide a safe environment to build endurance. Exercise, including both aerobic activity and resistance training, improves the body’s ability to use oxygen efficiently, reducing the workload on the heart. Research shows that consistent physical activity can lead to improvements in Ejection Fraction and is associated with better overall outcomes.
Eliminating substances that directly damage the heart muscle is necessary for improvement. Both smoking and excessive alcohol consumption are linked to a lower Ejection Fraction and can worsen symptoms. Quitting smoking removes harmful toxins that constrict blood vessels and increase blood pressure, while abstaining from alcohol removes a direct cardiotoxin. Managing weight is also beneficial, as excess body mass increases the volume of blood the heart must pump. Even if weight loss does not directly increase the EF percentage, it can significantly reduce symptoms and improve a person’s functional status.
Advanced Device and Procedural Options
For individuals whose Ejection Fraction remains significantly reduced despite consistent use of cornerstone drug classes and adherence to lifestyle changes, advanced interventions become necessary. Device therapies are designed to either improve the mechanical timing of the heart or protect against sudden, life-threatening rhythm problems. Cardiac Resynchronization Therapy (CRT) is a specialized pacemaker system used when the heart’s lower chambers, the ventricles, are contracting out of sync.
CRT involves placing wires, or leads, to stimulate both the left and right ventricles simultaneously, ensuring they pump together in a coordinated manner. This resynchronization can significantly improve the heart’s mechanical efficiency, leading to a notable increase in Ejection Fraction for many patients. Another common device is the Implantable Cardioverter-Defibrillator (ICD), primarily a protective measure for those with a very low EF.
While an ICD does not improve the Ejection Fraction itself, it constantly monitors the heart rhythm and delivers an electrical shock to stop a dangerous, rapid heart rhythm, thereby preventing sudden cardiac death. The presence of a low EF often indicates a higher risk for these electrical disturbances, making the ICD a common and necessary safeguard. For the small subset of patients whose condition continues to decline, even with optimal medical and device therapy, options like a Ventricular Assist Device (VAD) or heart transplant evaluation are considered. A Left Ventricular Assist Device (LVAD) is a mechanical pump that takes over the work of the weakened left ventricle, often serving as a bridge to transplant or as a permanent support solution.