Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction

Abstract

Background Many patients with heart failure ( HF ) with reduced ejection fraction ( HF r EF ) experience improvement or recovery of left ventricular ejection fraction ( LVEF ). Data on clinical characteristics, outcomes, and medical therapy in patients with HF with improved ejection fraction (HFiEF) are scarce. Methods and Results Of 5625 consecutive patients hospitalized for acute HF in the KorAHF (Registry [Prospective Cohort] for Heart Failure in Korea) study, 5103 patients had baseline echocardiography and 2302 patients had follow‐up echocardiography at 12 months. HF phenotypes were defined as persistent HF r EF ( LVEF ≤40% at baseline and at 1‐year follow‐up), HF i EF ( LVEF ≤40% at baseline and improved up to 40% at 1‐year follow‐up), HF with midrange ejection fraction (LVEF between 40% and <50%), and HF with preserved ejection fraction ( LVEF ≥50%). The primary outcome was 4‐year all‐cause mortality from the time of HF i EF diagnosis. Among 1509 HF r EF patients who had echocardiography 1 year after index hospitalization, 720 (31.3%) were diagnosed as having HF i EF . Younger age, female sex, de novo HF , hypertension, atrial fibrillation, and β‐blocker use were positive predictors and diabetes mellitus and ischemic heart disease were negative predictors of HF i EF . During 4‐year follow‐up, patients with HF i EF showed lower mortality than those with persistent HF r EF in univariate, multivariate, and propensity‐score–matched analyses. β‐Blockers, but not renin–angiotensin system inhibitors or mineralocorticoid receptor antagonists, were associated with a reduced all‐cause mortality risk (hazard ratio: 0.59; 95% CI , 0.40–0.87; P =0.007). Benefits for outcome seemed similar among patients receiving low‐ or high‐dose β‐blockers (log‐rank, P =0.304). Conclusions HF i EF is a distinct HF phenotype with better clinical outcomes than other phenotypes. The use of β‐blockers may be beneficial for these patients. Clinical Trial Registration URL : https://www.clinicaltrials.gov . U...

Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test

“…In such a context, Nadruz and colleagues reported a lower risk of cardiovascular events in rec-HFmrEF than in HFrEF and, quite surprisingly, even lower than in de novo HFmrEF (2). Similar results have been achieved also in a large registry study by Park CS and colleagues where it has been shown a lower rate of all-cause mortality in the rec-HFmrEF subset (35). Due to the significant differences in the study design, such as the primary outcome (i.e.…”

“…they explored a combined endpoint of all-cause mortality), as well as in the characteristic of the analyzed sample (i.e. they evaluated acutely decompensated patients), a comparison between our results and those presented by Park and colleagues cannot be feasible or, even, misleading (35). Conversely, with respect to the rec-HFmrEF population studied by Nadruz (2), besides the consistently larger cohort evaluated (1176 versus 170 patients), there are some aspects worthy to be discussed briefly.…”

Characteristics and outcomes of transitions among heart failure categories: a prospective observational cohort study

“…Regarding the effect of guideline‐directed medical therapy in LVEF improved patients, patients prescribed with beta‐blockers had lower 4 year all‐cause mortality . In a multivariate analysis, only the use of beta‐blockers was associated with a 41% reduced risk of mortality, whereas the effect of RAS inhibitor and MRA use on mortality appeared to be neutral . It was also reported that patients who were adherent to beta‐blockers were more likely to transition from HFrEF to HFpEF than were patients who were non‐adherent to beta‐blockers, whereas RAS inhibitor adherence was not associated with LVEF transitions .…”

Current status of heart failure: global and Korea

“…In addition, as the LVEF is not static, but changes during follow-up, some authors suggest reclassification of HF according to longitudinal LVEF changes. Patients with LVEF < 40% at baseline and > 40% at follow-up were defined as having HF with recovered ejection fraction (HFrecEF) or HF with improved ejection fraction (HFiEF) [14], whereas those with LVEF > 50% at baseline and < 40% at follow-up were defined as having HF with a declined ejection fraction (HFdEF) [15].…”

“…In the KorAHF registry, 2,302 (75%) patients with HFrEF had baseline and follow-up echocardiography at 12 months. HF phenotypes were defined as persistent HFrEF (LVEF ≤ 40% at baseline and at the 1-year follow-up) or HFiEF (LVEF ≤ 40% at baseline and improved to > 40% at 1-year follow-up), and those with HFiEF had a lower mortality rate compared to patients with persistent HFrEF [14]. Regarding medical treatment, beta-blockers, but not RAS inhibitors or MRAs, were associated with a reduced all-cause mortality risk.…”