Key result
Heart failure with improved ejection fraction is an increasingly recognized phenotype characterized by previously reduced ejection fraction (≤40%) that improves to >40%, requiring ongoing management.
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“We found that nearly 1 in 3 of our patients saw their ejection fraction improve in the first year of being on these medications. But as our study showed, although their heart function has improved, these patients are still at high risk for worsening heart failure, and they still need treatment.”
“We've seen from our data that improvement in left ventricular ejection fraction does not mean complete resolution of clinical risk. These patients are still at high risk for coming back into the emergency department with worsening heart failure episodes.”
“Heart failure with improved ejection fraction is a very common clinical entity, yet we have very little data about therapeutic escalation and therapeutic de-escalation in select patients. It elucidated that data gap for us.”
HFimpEF is increasingly recognized as a distinct phenotype where patients remain at risk for adverse outcomes despite LVEF recovery, highlighting the need for continued management and research.
Heart failure with improved ejection fraction (HFimpEF) has gained increasing recognition as a distinct phenotype within the spectrum of heart failure, characterized by previously reduced left ventricular ejection fraction (≤40%) that subsequently improves to >40%. HFimpEF remains relatively understudied, and uncertainty persists regarding its long-term prognosis and optimal management. Contemporary registries and clinical trials suggest a rising prevalence, likely reflecting both the increased implementation of guideline-directed medical therapy and evolving consensus definitions for its identification. Despite left ventricular ejection fraction recovery, patients with HFimpEF remain at risk for adverse outcomes, and their management remains an area of active investigation. The aim of this review is to provide an in-depth evaluation of HFimpEF, including its epidemiology, pathophysiology, prognosis, and treatment strategies. The authors also highlight existing clinical gaps and propose future research directions to refine risk stratification and therapeutic approaches for this evolving population.
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Riccardi et al. (2025) conducted a review in Heart failure with improved ejection fraction (HFimpEF). Heart failure with improved ejection fraction is an increasingly recognized phenotype characterized by previously reduced ejection fraction (≤40%) that improves to >40%, requiring ongoing management.
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