Heart failure patients with improved ejection fraction (HFimpEF) had fewer hospitalizations (3% vs. 8.54%, p=0.0207) and lower mortality (2.45% vs. 7.79%, p=0.0178) compared to HFrEF.
Does the development of HFimpEF improve clinical outcomes compared to persistent HFrEF in patients receiving SGLT2 inhibitors?
In a real-world cohort of patients on SGLT2 inhibitors, the development of HFimpEF was associated with significantly better clinical outcomes, including lower mortality and fewer hospitalizations, compared to persistent HFrEF.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Heart Failure (HF) with improved ejection fraction (HFimpEF) refers to a subset of HF patients previously diagnosed with HF with reduced ejection fraction (HFrEF) that experience an improvement in left ventricular ejection fraction (LVEF) (1). Several studies have identified HFimpEF as distinct clinical entities that differ significantly from both HFrEF and HF with preserved ejection fraction (HFpEF). Previous HFrEF patients who developed HFimpEF during follow-up were shown to have both a better prognosis and a significant improvement in health-related quality of life (2). While guideline-directed medical therapy (GDMT) should be maintained to achieve HFimpEF in patients with HFrEF (2), real world dana is lacking, particularly since the introduction of SGLT2 inhibitors. This study aimed to assess HFimpEF prevalence, prognosis, factors associated with improvement in LVEF. Methods This prospective observational study at our institution enrolled HF patients from May 2021 to December 2024. Data on demographics, comorbidities, biomarkers, LVEF, and adverse events were collected. HFimpEF was defined as an initial LVEF 40% with a ≥10% improvement to 40%. We included HF patients regardless of cause and from various clinical contexts. GDMT was initiated and escalated according to the cardiologist in charge, with no study protocol regarding medical therapy. Only patients receiving SGLT2 inhibitors were included. Statistical analysis was performed using MedCalc 23.0.9. Results A total of 561 HF patients (median age 67 years, 24.4% female) were followed for at least six months (Table 1). Most had NYHA class II or III, with a median LVEF of 32% (IQR 25%-35%). HFimpEF was observed in 163 patients (29%) at six months and 181 (32%) at 12 months. It was more common in non-ischemic HF (34.3% vs. 25.1%, p=0.0173) and AF patients post-ablation (64% vs. 25%, p0.0001). HFimpEF patients had higher initial LVEF (35% vs. 30%, p0.0001), but NT-proBNP levels were similar (p=0.2435). GDMT was initiated in 475 patients (84.7%), with similar rates in HFimpEF and persistent HFrEF groups (86% vs. 84%, p=0.6083). HFimpEF was more frequent in those receiving empagliflozin (35% vs. 25%, p=0.018) and ACE inhibitors/ARBs compared to sacubitril/valsartan (36.36% vs. 20.16%, p0.0001). HFimpEF patients had fewer emergency visits (9.8% vs. 20.3%, p=0.0028), HF hospitalizations (3% vs. 8.54%, p=0.0207) and all-cause deaths (2.45% vs. 7.79%, p=0.0178) when compared to HFrEF group. Conclusion HFimpEF is associated with better outcomes, including fewer hospitalizations and lower mortality. In our real-world cohort, it was more common in non-ischemic HF, AF patients post-ablation, and those on empagliflozin. Further research is needed to validate these findings, identify patients less likely to recover, and optimize treatment strategies for those requiring more intensive management.Table 1
Vidak et al. (Sat,) reported a other. Heart failure patients with improved ejection fraction (HFimpEF) had fewer hospitalizations (3% vs. 8.54%, p=0.0207) and lower mortality (2.45% vs. 7.79%, p=0.0178) compared to HFrEF.
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