Can ejection fraction improve? What I learned going from 15% to normal.
When I was diagnosed, my ejection fraction was 15%. Today it's back in the normal range. Here's what EF actually measures, what can help it improve, and what I learned along the way.
By Gareth Robinson
Updated
5 min read
In short
- Ejection fraction (EF) is the percentage of blood your heart pumps out with each beat. A normal EF is typically 50 to 70%.
- For some people with a reduced EF, heart function can improve, sometimes back into the normal range.
- Improvement is most likely when the cause can be treated and treatment is followed consistently.
- An improved EF doesn't mean heart failure has gone. Keep taking your medicines unless your cardiologist advises otherwise.
What ejection fraction means
Each time your heart beats, its main pumping chamber (the left ventricle) squeezes out some of the blood inside it. Ejection fraction is the percentage it pushes out. If your EF is 60%, your heart is pumping out 60% of the blood in that chamber with each beat.
EF is usually measured with an echocardiogram, an ultrasound scan of the heart. It's often used to describe heart failure:
- 50 to 70%: the typical normal range.
- 41 to 49%: mildly reduced.
- 40% or lower: reduced. Mine was 15%, which is severely reduced.
Some people have heart failure with a normal EF (called heart failure with preserved ejection fraction). Their heart muscle is stiff and doesn't fill properly, so EF alone doesn't tell the whole story. Your care team looks at the full picture.
Can ejection fraction improve?
Yes, for some people it can. Doctors even have a name for it: heart failure with improved ejection fraction. It describes people whose EF was reduced and has since risen.
How much it improves, and whether it improves at all, varies a lot from person to person. It depends on what caused the heart failure, how long the heart has been affected, other health conditions, and how well treatment works for you.
My EF going from 15% to normal is real, and I hope it gives you hope. But every heart is different. Please use my story as encouragement, not as a prediction for yours. Your cardiologist is the best person to talk to about what's realistic for you.
What can help ejection fraction improve
These are the things that heart failure guidance and specialists commonly point to. Your own care team will tell you which apply to you.
Treating the cause
If something specific caused or worsened your heart failure, such as a heart rhythm problem, a valve problem, high blood pressure or alcohol, treating it can give the heart the chance to recover. Ask your team whether a cause has been found.
Taking your medicines consistently
Several heart failure medicines are designed to reduce strain on the heart and help it work better over time. They often start at low doses and are increased gradually. Taking them every day, exactly as prescribed, matters, even on days you feel well.
Devices, when recommended
Some people are offered a device, such as a special pacemaker, to help the heart pump in a more coordinated way. Your specialist will tell you if one might help.
Daily habits
Following advice on salt and fluids, staying as active as your team recommends, stopping smoking, keeping alcohol within the limits you've been given, sleeping well and managing stress all support your heart and your general health.
Cardiac rehabilitation
Supervised exercise and education help you get stronger safely, and rebuild the confidence that a diagnosis can knock out of you.
How long does it take?
There's no fixed timeline. Where improvement happens, it's usually measured over months rather than weeks, often as medicines are adjusted to the right doses. Your care team will usually repeat your echocardiogram at some point to see how your heart is responding.
It's worth knowing that how you feel and what your EF shows don't always move together. Some people feel much better before their scan changes, and others see their numbers improve before their energy fully returns.
Improved isn't the same as cured
This is the part I most want people to hear. When your EF improves, it's tempting to think the problem has gone and you can stop your medicines. Please don't do that without talking to your cardiologist. In many people the medicines are part of the reason the heart improved, and stopping them can allow it to weaken again.
Keep doing your daily checks, keep going to your reviews and keep the habits that got you there.
What helped me
I can't tell you exactly which part of my treatment made the difference, and I'd be wary of anyone who claims to know for certain. What I can tell you is what my recovery was built on:
- Understanding my condition. Once I knew what my numbers and medicines meant, I felt less helpless and more in control.
- Daily habits. Taking my medicines every day, weighing myself every morning and noticing changes early.
- Nutrition. Following the advice I was given on salt and fluids, and eating with my heart in mind.
- Movement. Building up activity gradually and safely, instead of being frightened of it.
- Mindset. With Katrina's support, working through the fear that came with the diagnosis.
- A realistic plan. Small steps I could actually stick to, rather than trying to change everything at once.
Small, steady steps, repeated every day, added up to more than I ever expected.
If you want to start with the daily habits, our free Daily Heart Check helps you track your weight and symptoms in about a minute a day.
Common questions
What is a normal ejection fraction?
A normal ejection fraction is typically between 50 and 70%. An EF of 41 to 49% is described as mildly reduced, and 40% or lower as reduced.
Can exercise improve ejection fraction?
Regular, appropriate exercise is an important part of heart failure care and improves fitness, strength and quality of life. Its effect on EF itself varies from person to person. Ask your care team what activity is right for you, ideally through a cardiac rehabilitation programme.
If my ejection fraction improves, is my heart failure gone?
Not necessarily. An improved EF is excellent news, but heart failure is usually still managed as a long-term condition. Don't stop or reduce any medicine without speaking to your cardiologist.
Heart failure patient and cardiac rehab trainer. Gareth was diagnosed with heart failure and an ejection fraction of 15%, and his heart function has since returned to the normal range. He co-founded Living with Heart Failure with his wife, Katrina.
This guide shares lived experience and general information. It does not replace advice from your cardiologist, GP or heart failure team. Always follow the plan your own care team gives you.