Long-term outcome of heart failure patients with improved ejection fraction: Results from a real-world registry

Abstract

Aims This real-world cohort study aims to elucidate the characteristics and long-term outcome of heart failure patients with improved ejection fraction (HFimpEF). Methods Data from a prospective observational single-center registry were analyzed. Adult patients with reduced left ventricular ejection fraction (LVEF)(≤40%) were classified as HFimpEF if follow-up LVEF improved to >40%. Primary outcome was defined as the composite of all-cause death, left ventricular assist device implantation, or heart transplantation. Results We identified 207 HFimpEF patients (33%) among 635 HF patients with reduced LVEF. Their LVEF improved from 27% (interquartile range, IQR 21,34) to 45% (IQR 43,50, P < 0.001) over a median duration of 3.1 years. The 10-year primary outcome-free survival probability was 82.8%. Among the twenty-two observed deaths, only four were attributed to cardiovascular causes. In the multivariable Cox regression analysis, history of cancer (adjusted hazard ratio, aHR 2.72 [95% confidence interval, CI 1.11–6.65], P = 0.028) and septal E/e’ ratio (aHR 1.09 [95%CI 1.03–1.16], P = 0.006) were identified as independent predictors for primary outcome. A subgroup of patients treated with renin-angiotensin system inhibitors (RASi) and β-blockers alone (n = 47) had a higher 10-year survival than those who required additional drugs (94.3%vs.78.3%, log-rank P = 0.021). Conclusions The cardiovascular long-term outcome of HFimpEF patients was generally favorable, with most deaths due to non-cardiovascular causes. A history of cancer and an elevated E/e’ ratio independently predicted the composite of death and advanced HF therapy. Future trials are warranted to determine the optimal long-term pharmacotherapeutic management of this population.