The 2 Types of Heart Failure to Know About

Written by: Dr. Raquel Hammonds
December 4, 2025

Heart failure is one of those medical terms that sounds like a sudden event — something catastrophic or final. But in reality, heart failure usually develops slowly, over months or years, as the heart loses strength or becomes too stiff to pump blood the way the body needs.¹ It’s a chronic condition, not an immediate collapse, and it affects more than 6.7 million Americans.²

Despite how common it is, heart failure remains misunderstood. Many people don’t know what causes it, what symptoms to look for, or that there are actually two different types, each affecting the heart in its own way. Without this understanding, symptoms go unnoticed, treatment is delayed, and preventable complications arise.

Black and Brown communities carry a heavier burden of heart failure than any other population in this country.³ Understanding the types of heart failure isn’t just about medical knowledge, it’s about giving our communities the power to recognize early warnings and advocate for timely care.

What Heart Failure Really Means

Heart failure doesn’t mean the heart has shut down. It means the heart is struggling, and the body is working overtime to compensate.¹ As the heart weakens or stiffens, pressure builds inside the blood vessels and fluid begins seeping into the lungs and tissues.¹

This leads to symptoms like breathlessness, trouble lying flat, swelling in the legs or abdomen, persistent coughing, or rapid weight gain from fluid retention.²

People may chalk these symptoms up to age, stress, or being out of shape, but in many cases, these are the earliest signals that the heart is losing ground.

The 2 Types of Heart Failure

Heart failure falls into two main categories. The symptoms can overlap, but the underlying problems and the treatments differ.

1. Heart Failure With Reduced Ejection Fraction (HFrEF)

(Systolic heart failure)

In this form of heart failure, the heart muscle has become weak.⁴ It can no longer squeeze with the same force it once did. The term “ejection fraction” refers to the percentage of blood the heart pushes out with each beat.⁴

A healthy ejection fraction is usually 55% to 60%.⁴ In HFrEF, the ejection fraction falls below 40%, meaning the heart isn’t pumping out enough blood to keep the body fully supplied.⁴

When the pumping action weakens, the body begins rationing energy.⁴ Less blood reaches the muscles, brain, and kidneys, which causes fatigue, brain fog, cold hands and feet, and swelling.⁴

The heart often enlarges in an attempt to compensate, but this stretching only makes the problem worse over time. HFrEF can develop after a heart attack, long-standing high blood pressure, viral infections that damage the heart, or untreated conditions like diabetes or sleep apnea.⁴

2. Heart Failure With Preserved Ejection Fraction (HFpEF)

(Diastolic heart failure)

HFpEF works differently. In this form of heart failure, the heart is not weak, it’s stiff.⁴ It can still squeeze normally, so the ejection fraction often appears “normal”, but the heart cannot relax or expand enough to fill with an adequate amount of blood.⁴ Because each beat starts with less blood inside the chamber, the total amount pushed out is lower than the body needs, even if the percentage looks normal.⁴

This form of heart failure is often tied to inflammation and long-term stress on the heart muscle.⁴ People with HFpEF commonly experience shortness of breath during mild activity, especially when walking or carrying groceries.⁴

They may feel extreme fatigue or notice swelling in the legs or abdomen.⁴ HFpEF is strongly associated with high blood pressure, obesity, diabetes, aging, kidney disease, and chronic stress — all conditions that disproportionately impact Black and Brown adults.⁴

HFpEF is becoming the most common form of heart failure, and it often goes undiagnosed because symptoms develop gradually and can be mistaken for aging or inactivity.⁴

Why Black and Brown Communities Face Higher Rates of Heart Failure

Heart failure does not strike every community equally. Black adults develop heart failure at younger ages and are more likely to experience severe complications.³ These disparities are not explained by genetics alone, they are shaped by decades of inequities that influence where people live, the types of jobs they work, the quality of healthcare they receive, and the chronic stress they endure.³

Many Black and Brown communities experience higher rates of high blood pressure, diabetes, kidney disease, and inflammation — all major drivers of heart failure.³ These conditions often go untreated or undertreated due to limited access to consistent primary care.³ Once symptoms appear, they are more likely to be dismissed or misdiagnosed, delaying treatment until the disease has progressed.³

Environmental factors also play a major role. Living in neighborhoods with fewer green spaces, limited grocery access, higher pollution, and chronic stress exposure creates a backdrop where heart failure becomes more likely and more difficult to manage.³ For many, the heart is not failing by accident, it is responding to years of cumulative strain.³

Understanding the types of heart failure allows people to recognize early warning signs and seek care long before the condition becomes advanced.

How Heart Failure Is Diagnosed

Diagnosing heart failure requires a closer look at how the heart pumps and fills, which means doctors rely on several key tests.⁵

The most important is an echocardiogram, an ultrasound that shows how strongly the heart squeezes, how well it relaxes, and whether the ejection fraction is reduced or preserved.⁵

Doctors may also perform an EKG to evaluate electrical activity, blood tests that detect strain on the heart, or a chest X-ray to check for fluid in the lungs.⁵

These tests together allow doctors to determine which type of heart failure is present and guide treatment plans that support both longevity and quality of life.

Protecting Your Heart Starts With Paying Attention

Heart failure rarely begins with dramatic symptoms. It often begins with subtle changes — a little more shortness of breath, a little more swelling, a little more fatigue. If you live with high blood pressure, diabetes, kidney disease, sleep apnea, or a family history of heart problems, these symptoms should not be ignored.

Routine check-ups, heart imaging, and early conversation with your provider can make an enormous difference in how heart failure progresses and how well it can be managed.

A Call to Action For Our Communities

Understanding the difference between these two types of heart failure allows our community to recognize the earliest signs and advocate for the testing we deserve. If something feels wrong — if breathing feels harder, if swelling appears, if your energy changes — take it seriously.

Ask for an evaluation. Request an echocardiogram. Encourage your loved ones to do the same. Your heart has carried you this far. The knowledge you gain today can help carry you even farther.