Heart failure with improved ejection ejection fraction, what can we expect?

Introduction

Heart failure with improved ejection fraction (HFimpEF) is related to better prognosis. Nevertheless, the risk of adverse outcomes remains higher, and its progression and long-term impact are not well established.

The purpose of our study was to evaluate the evolving natural history of a cohor of patients with HEimpEF.

Purpose and Methods

It is an observational, retrospective, single-centred study. We included consecutive patients from our HF Unit that achieved left ventricular ejection fraction (LVEF) recovery from 2016-2021. HFimpEF was established as a baseline LVEF of 40%, with a >10% point increase and a second measurement ≥ 40%.

Our patients were evaluated until 2025, attending to their clinical status, LVEF value and admissions for heart failure during the follow-up.

Results

150 patients were included, with a median age of 63.5 years; 77.3% were men. With regard to the aetiology, it was non-ischaemic more frequent (63.3%), and 56.7% of patients (48.7-64.4) had de novo heart failure.

LVEF at time of inclusion was ≥50% in more than half of patients (55.3%), with a median value of 51%. During the follow-up, 83.4% and 55.9% patients maintained an LVEF of ≥40% and ≥50% respectively. The median time to LVEF relapse was 3.87 years [CI 95% (2.19-5.39)].

Regarding adverse events among this group, 17.8% of patients had at least one readmission for acute heart failure. 15.3% died - the majority due to non cardiovascular cause (63.3%).

Conclusions

Patients with HFimpEF from our HF Unit are at significant risk of EF relapse, and rates of mortality and readmissions during the first four years remain high. This reflects the importance of continuation of guideline directed management and therapy, and to establish and effective patient follow-up regardless of EF.