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Introduction: Limited data are available on the epidemiology and predictors of improvement or recovery of left ventricular ejection fraction (LVEF) in outpatients with heart failure (HF) and reduced (≤40%) LVEF (HFrEF). Also, data on the impact of LVEF improvement on outcomes in these patients are scarce. Hypothesis: We hypothesized that (1) clinical characteristics of outpatients with HFrEF can predict improvement of LVEF (to >40%) by 1 year and (2) LVEF improvement (to >40%) leads to lower risk for subsequent events (death and HF admissions). Methods: We evaluated 805 patients with HFrEF who received outpatient care from 01/01/12 to 03/ 31/12 (inception period) and extracted data on serial echocardiographic assessments, interim advanced HF therapies, and outcomes. To assess impact of LVEF trajectory on outcomes, we performed a landmark analysis at 1 year follow-up. Results: Among 724 patients who were alive at 1 year and had not received advanced HF therapies in the interim, 380 (52.5%) had repeat echocardiograms. Of those, 57/380 (15.0%) had improved LVEF to >40% (median change, +18%; 25th to 75th percentile, +10% to +25%), whereas 323 did not improve (0%; -5% to +5%). Table 1 presents the baseline characteristics according to 1-year LVEF change. Baseline LVEF ≥30% (odds ratio [OR] 5.06; 95%CI 2.62-9.77; P < .001), nonischemic HF (OR 2.11; 95%CI 1.11-4.02; P=.023), and absence of implantable cardioverter defibrillator (OR 3.37;; P=.009) predicted LVEF improvement to >40%. In a subset of 272 patients with data on HF duration, improvement was less likely with longer HF duration (OR per year 0.83; 95%CI 0.72-0.94; P=.005). In a landmark analysis at 1 year, 5/57 patients with improved LVEF died in the next 2 years vs. 55/323 among nonimprovers (2-year mortality: 10.1% vs. 17.1%, log-rank P=.13). Improvers had significantly lower rates of combined death or HF admission vs. non-improvers (Fig. 1), hazard ratio 0.37 (95%CI 0.20-0.70; P=.002) in adjusted models. Conclusions:In our chronic HFrEF cohort, 15% of patients improved their LVEF within 1 year. These patients experienced lower rates of combined mortality and HF admission in the next 2 years.

and medication non-adherence in patients with AF was examined. Methods: Studies published between 2005 and 2015 on medication non-adherence and depression in patients with AF were examined. The key terms for screening were atrial fibrillation, medication adherence, stroke risk and depression. They were used in Medline, PubMed and Google Scholar. Results: Only 7 epidemiological studies of about 1500 patients assessed depression in patients with atrial fibrillation with 50% having depression. 5 studies assessed medication adherence in AF patients (depression was not measured in these studies). Persistence at 18 months was noted in fewer than 25% of patients. Unfortunately, depression was not assessed in these persistence trials. The recent trials of the new anticoagulant drugs (NOACs) vs. Warfarin included almost 100,000 patients. High discontinuation rates were noted of about 10% / year. Depression was not measured in these trials either. Depression is known to be a major risk factor in patients with CHD and heart failure and depressed patients are three times more likely to be non-adherent. Conclusion: Depression is a major factor for poor adherence and highly prevalent in AF patients. Treatment of depression improves adherence per se and is likely to decrease complications of AF. Screening for depression ought to be included in guidelines for management of AF.

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