Patients with heart failure with improved ejection fraction experienced a significantly lower risk of cardiovascular death compared to those with persistent HFrEF (HR 0.518).
Cohort (n=734)
Yes
Does achieving and maintaining an improved ejection fraction (persistent HFimpEF) reduce mortality and heart failure rehospitalization in patients with HFrEF?
Patients with HFrEF who achieve and persistently maintain an improved ejection fraction (>40%) have significantly lower risks of cardiovascular and all-cause mortality compared to those with persistent HFrEF or transiently improved LVEF.
Effect estimate: HR 0.518 (95% CI 0.281-0.957)
Absolute Event Rate: 9.3% vs 18.2%
p-value: p=0.036
BACKGROUND: Heart failure with improved ejection fraction (HFimpEF) has been regarded as a new heart failure (HF) type in 2022. However, studies on the impact of left ventricular ejection fraction (LVEF) trajectories on the prognosis of patients with HFimpEF are scarce. In this study, we investigated dynamic trajectories of LVEF and different clinical outcomes in HFimpEF. METHODS AND RESULTS: This was a multi-center study included patients diagnosed with HF with reduced ejection fraction (HFrEF) between January 1, 2015, and October 31, 2022. Enrolled patients were divided into HFimpEF and persistent HFrEF groups. To further investigate different LVEF trajectories in HFimpEF patients, they were classified into persistent HFimpEF and transient HFimpEF subgroups. Adverse clinical outcomes encompassed all-cause death, cardiovascular death, and HF-related rehospitalization. A total of 734 patients were included (HFimpEF: n = 162; persistent HFrEF: n = 572). Cox regression analysis revealed that compared with persistent HFrEF, patients with HFimpEF experienced a lower risk of all-cause and cardiovascular death. Subgroup analysis determined that only 113 (69.75%) patients maintained an LVEF exceeding 40%. Cox regression analysis revealed that persistent HFimpEF patients had a lower risk of all-cause and cardiovascular death compared to those with transient HFimpEF. Finally, multivariate logistic analysis showed that gender and high-density lipoprotein cholesterol levels were independent predictors of persistent HFimpEF. CONCLUSIONS: HFimpEF does not accurately represent HF recovery, given that there are different trajectories of LVEF in HFimpEF. Patients with persistent HFimpEF experience better clinical outcomes, highlighting clinicians should identify clinical modifiable factors to maintain a stable HF stage for better prognosis. TRIAL REGISTRATION: ChiCTR2400086622, 08/07/2024.
Jiang et al. (Tue,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=734). Heart failure with improved ejection fraction (HFimpEF) vs. Persistent HFrEF was evaluated on Cardiovascular death (HR 0.518, 95% CI 0.281-0.957, p=0.036). Patients with heart failure with improved ejection fraction experienced a significantly lower risk of cardiovascular death compared to those with persistent HFrEF (HR 0.518).