Achieving recovered heart failure was associated with a significantly lower risk of all-cause mortality and heart failure hospitalization compared to non-improved heart failure (HR 0.36; p≤0.01).
Cohort (n=1,690)
No
Does a multidimensional classification of HF trajectory (improved, remission, recovered) predict mortality and HF hospitalizations in outpatients with LVEF <50%?
Applying a multidimensional classification of HF trajectory provides meaningful prognostic discrimination, demonstrating that patients achieving remission or recovery have substantially lower risks of mortality and HF hospitalization.
Hazard Ratio: 0.36
p-value: p=≤0.01
Abstract Background Heart failure (HF) with improved ejection fraction (LVEF) refers to patients whose left ventricular ejection fraction improves over time or because of treatment, though outcomes vary—some maintain recovery while others remain at risk of relapse, requiring individualized long-term care. A recent expert consensus has introduced a more nuanced classification: improved-HF, HF-in-remission, and recovered-HF, incorporating clinical and biomarker data. Aims To apply this new framework in a real-world cohort of outpatients with HF with reduced LVEF and evaluate its prognostic utility in predicting mortality and HF-related hospitalizations after therapy. Methods We prospectively evaluated 1,690 ambulatory patients with LVEF 50% referred to a university hospital HF clinic (2006–2023). Patients were categorized as HF not improved, improved-HF, HF-in-remission, and recovered-HF based upon LVEF improvement, symptoms (NYHA) and NT-proBNP levels after one year. The primary outcome was a composite of all-cause mortality and HF hospitalization. Cox and negative binomial regressions assessed risk. Results Patients were classified as HF not improved (n=898, 61%), improved-HF (n=374, 25%), remission-HF (n=147, 10%), and recovered-HF (n=57, 4%). Two-hundred fourteen patients did not size in any of these groups. Over 5.2 ± 4.0 years follow-up, 738 deaths and 847 HF hospitalizations occurred. Compared to the HF not improved group, adjusted hazard ratios for the composite endpoint were 0.61 for improved-HF, 0.48 for HF-in-remission, and 0.36 for recovered-HF (all p ≤0.01). Recurrent HF hospitalizations declined significantly across groups, with none occurring in recovered-HF. Mortality in recovered-HF was rare and mainly non-cardiovascular. Conclusion This multidimensional classification of HF trajectory provides meaningful prognostic discrimination. Patients achieving remission or recovery have substantially better outcomes, supporting its utility in guiding therapy intensity and monitoring.
Bayes-Genis et al. (Tue,) conducted a cohort in Heart failure with reduced LVEF (n=1,690). Recovered heart failure vs. Heart failure not improved was evaluated on Composite of all-cause mortality and HF hospitalization (HR 0.36, p=≤0.01). Achieving recovered heart failure was associated with a significantly lower risk of all-cause mortality and heart failure hospitalization compared to non-improved heart failure (HR 0.36; p≤0.01).