Heart Failure with Recovered Ejection Fraction Long-Term Outcomes and Risk Stratification

Among patients with heart failure (HF), a recovered ejection fraction (recEF) does not mean the patient is “cured.” It is recommended that physicians use New York Heart Association functional class, diuretic dose, and B-type natriuretic peptide (BNP) to accurately model risk of mortality in these patients. These findings were published in The American Journal of Cardiology.

Researchers sought to examine long-term outcomes in patients with HFrecEF, classify what might predict adverse events, and design a risk stratification model. To accomplish this, they conducted a retrospective study of 133 patients (median aged 66 years [IQR, 55-75]; 38% women; 77% White; 30% had ischemic etiology; 59% had history of hypertension) from clinics at the University of Washington Medical Center, Harborview Medical Center, and Northwest Hospital in Seattle, Washington. Patients were enrolled between 2010 and 2018, and had improved left ventricular ejection fraction (LVEF) of less than 40% to 53% or more.

Median follow-up was 3.1 years. Survival at 1 year, 3 years, and 5 years was 92%, 83%, and 70%, respectively. Freedom from hospitalization at 1 year was 58% and risk for LVEF reduction below 40% at 3 years was 28%. At the time of LVEF recovery, the best predictors of hospitalization and death were BNP and diuretic dose. Combining these with the New York Heart Association (NYHA) functional class developed an accurate hazard risk model for all-cause mortality.

Study limitations include selection bias, sampling bias, and unaccounted for hospitalizations and deaths. The results were also limited in generalizability, as the study took place in only 3 medical centers within the same healthcare organization.

The researchers concluded, “HFrecEF is a recently recognized HF phenotype with heterogenous long-term clinical outcomes, and this population should not be viewed as ‘cured’ from HF.” The most significant predictors of all-cause death and future hospitalization is the BNP and diuretic dose. Researchers believe their risk model “…incorporating diuretic dose, BNP, and NYHA functional class at the time of recovery can accurately stratify mortality risk in patients with HFrecEF.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Perry AS, Mudigonda P, Huang GS, et al. Long-term outcomes and risk stratification of patients with heart failure with recovered ejection fraction. Am J Cardiol. Published online April 2, 2022. doi:10.1016/j.amjcard.2022.03.006