No abstract

Aims Significant recovery of left ventricular ejection fraction (LVEF) occurs in a proportion of patients with heart failure (HF) and reduced ejection fraction (HFrEF). We analysed outcomes, including mortality [all‐cause, cardiovascular (CV), HF‐related, and sudden death], and HF‐related hospitalizations in this HF‐recovered group. The primary endpoint was a composite of CV death or HF hospitalization. Methods and results LVEF was assessed at baseline and at 1 year in 1057 consecutive HF patients. Patients were classified into three groups: (i) HF‐recovered: LVEF <45% at baseline and ≥45% at 1 year (n = 233); (ii) HF with preserved EF (HFpEF): LVEF ≥45% throughout follow‐up (n = 117); and (iii) HFrEF: LVEF <45% throughout follow‐up (n = 707). Mean follow‐up was 5.6 ± 3.1 years. HF‐recovered patients differed from HFrEF and HFpEF groups in demographic and clinical characteristics. The mean LVEF increase was 21.1 ± 10 points in HF‐recovered patients. Using the HF‐recovered group as a reference, the risks for the primary composite endpoint (n = 376), with non‐CV death as competing risk, for HFpEF and HFrEF groups were: hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.60–3.39], P < 0.001 and HR 1.99 (95% CI 1.50–2.65), P < 0.001, respectively. All‐cause (n = 429), CV (n = 245), HF‐related (n = 127), and sudden death (n = 60) were significantly lower in HF‐recovered subjects relative to HFrEF (all P < 0.01). HF‐recovered patients also experienced less recurrent HF hospitalizations (P < 0.001). Conclusion One in four treated patients with HFrEF showed recovery of systolic function. HF‐recovered patients had significantly improved mortality and morbidity relative to HFpEF and HFrEF subjects. Further research is needed to identify optimal medications and device indications for HF‐recovered patients.

LVEF trajectories vary in HF depending on a number of disease modifiers, but an inverted U-shaped pattern with lower LVEF at both ends of the distribution emerged. A declining LVEF in the preceding period was associated with higher mortality.