Recovered Heart Failure With Reduced Ejection Fraction and Outcomes: A Prospective Study

Eur J Heart Fail. 2017 Dec;19(12):1615-1623. doi: 10.1002/ejhf.824. Epub 2017 Apr 6.

Abstract

Aims: Significant recovery of left ventricular ejection fraction (LVEF) occurs in a proportion of patients with heart failure (HF) and reduced ejection fraction (HFrEF). We analysed outcomes, including mortality [all-cause, cardiovascular (CV), HF-related, and sudden death], and HF-related hospitalizations in this HF-recovered group. The primary endpoint was a composite of CV death or HF hospitalization.

Methods and results: LVEF was assessed at baseline and at 1 year in 1057 consecutive HF patients. Patients were classified into three groups: (i) HF-recovered: LVEF <45% at baseline and ≥45% at 1 year (n = 233); (ii) HF with preserved EF (HFpEF): LVEF ≥45% throughout follow-up (n = 117); and (iii) HFrEF: LVEF <45% throughout follow-up (n = 707). Mean follow-up was 5.6 ± 3.1 years. HF-recovered patients differed from HFrEF and HFpEF groups in demographic and clinical characteristics. The mean LVEF increase was 21.1 ± 10 points in HF-recovered patients. Using the HF-recovered group as a reference, the risks for the primary composite endpoint (n = 376), with non-CV death as competing risk, for HFpEF and HFrEF groups were: hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.60-3.39], P < 0.001 and HR 1.99 (95% CI 1.50-2.65), P < 0.001, respectively. All-cause (n = 429), CV (n = 245), HF-related (n = 127), and sudden death (n = 60) were significantly lower in HF-recovered subjects relative to HFrEF (all P < 0.01). HF-recovered patients also experienced less recurrent HF hospitalizations (P < 0.001).

Conclusion: One in four treated patients with HFrEF showed recovery of systolic function. HF-recovered patients had significantly improved mortality and morbidity relative to HFpEF and HFrEF subjects. Further research is needed to identify optimal medications and device indications for HF-recovered patients.

Keywords: Heart failure with mid-range ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Left ventricular ejection fraction; Recovered.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cause of Death / trends
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / physiopathology*
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Hospitalization / trends
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function / physiology*
  • Risk Factors
  • Spain / epidemiology
  • Stroke Volume / physiology*
  • Survival Rate / trends
  • Time Factors
  • Ventricular Function, Left / physiology*