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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.

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