biostudies-literatureUnknown7(4)Arvanitaki A<h4>Aims</h4>Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if disease progression is unrecognized. We highlight the challenges in the definition of clinical stability and mild symptomatic status in HFrEF, outline clinical characteristics and available diagnostic tools, and discuss evidence and gaps in the current guidelines for the management of these patients.<h4>Methods and results</h4>This is a state-of-the-art review that focuses on clinical, diagnostic, and therapeutic aspects in mildly symptomatic HFrEF patients; summarizes the challenges; and proposes direESC heart failure1477-1487https://www.ebi.ac.uk/biostudies/studies/S-EPMC7373907biostudies-literatureMildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations.PMC7373907Karvounis HArvanitaki AKalogeropoulos AMichou EGiannakoulas GfalseMildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations.<h4>Aims</h4>Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if disease progression is unrecognized. We highlight the challenges in the definition of clinical stability and mild symptomatic status in HFrEF, outline clinical characteristics and available diagnostic tools, and discuss evidence and gaps in the current guidelines for the management of these patients.<h4>Methods and results</h4>This is a state-of-the-art review that focuses on clinical, diagnostic, and therapeutic aspects in mildly symptomatic HFrEF patients; summarizes the challenges; and proposes dire2020-01-01T00:00:00Z2020 Aug2025-04-19T11:35:52.523Z2025-04-19T11:35:52.523ZS-EPMC73739073236887310.1002/ehf2.12701