Heart failure with recovered ejection fraction was associated with lower all-cause mortality compared to persistent HFrEF (8.10% vs 18.84%; HR for persistent HFrEF 2.30, 95% CI 1.49-3.56, P=0.000).
Cohort (n=1,160)
Does heart failure with recovered ejection fraction (HFrecEF) reduce all-cause mortality and rehospitalization in adults with an initial diagnosis of HFrEF?
Heart failure with recovered ejection fraction is a distinct phenotype associated with significantly lower risks of all-cause mortality and rehospitalization compared to persistent HFrEF.
Effect estimate: HR 2.30 (95% CI 1.49-3.56)
Absolute Event Rate: 8.1% vs 18.84%
p-value: p=0.000
AIMS: There is an emerging interest in elucidating the natural history and prognosis for patients with heart failure with reduced ejection fraction (HFrEF) in whom left ventricular ejection fraction (LVEF) subsequently improves. The characteristics and outcomes were compared between heart failure with recovered ejection fraction (HFrecEF) and persistent HFrEF. METHODS AND RESULTS: This is a retrospective study of adults who underwent at least two echocardiograms 3 months apart between 1 November 2015 and 31 October 2019 with an initial diagnosis of HFrEF. The subjects were divided into HFrecEF group (second LVEF > 40%, ≥10% absolute improvement in LVEF) and persistent HFrEF group (20% subgroups. The primary outcomes were all-cause mortality and rehospitalization. A total of 1160 HFrEF patients were included 70.2% male, mean (standard deviation) age: 62 ± 13 years. On the second echocardiogram, 284 patients (24.5%) showed HFrecEF and 876 patients (75.5%) showed persistent HFrEF. All-cause mortality was identified in 23 (8.10%) HFrecEF and 165 (18.84%) persistent HFrEF, whilst 76 (26.76%) and 426 (48.63%) showed rehospitalizations, respectively. Survival analysis showed that the persistent HFrEF subgroup experienced a significantly higher mortality at 12 and 24 months and a higher hospitalization at 12, 24, 48, and more than 48 months following discharge. Multivariate Cox regression showed that persistent HFrEF had a higher risk of all-cause mortality hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.49-3.56, P = 0.000 and rehospitalization (HR 1.85, 95% CI 1.45-2.36, P = 0.000) than the HFrecEF group. Subgroup analysis showed that the LVEF ≥ 20% improvement subgroup had lower rates of adverse outcomes compared with those with less improvement of 10-20%. CONCLUSIONS: Heart failure with recovered ejection fraction is a distinct HF phenotype with better clinical outcomes compared with those with persistent HFrEF. HFrecEF patients have a relatively better short-term mortality at 24 months but not thereafter.
Zhang et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,160). Heart failure with recovered ejection fraction (HFrecEF) vs. Persistent HFrEF was evaluated on All-cause mortality (HR 2.30, 95% CI 1.49-3.56, p=0.000). Heart failure with recovered ejection fraction was associated with lower all-cause mortality compared to persistent HFrEF (8.10% vs 18.84%; HR for persistent HFrEF 2.30, 95% CI 1.49-3.56, P=0.000).