Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

Wohlfahrt, Peter; Nativi-Nicolau, José; Zhang, Mingyuan; Selzman, Craig H.; Greene, Thomas; Conte, Jorge; Biber, Joshua; Hess, Rachel; Mondesir, Favel L.; Wever‐Pinzon, Omar; Drakos, Stavros G.; Gilbert, Edward M.; Kemeyou, Line; LaSalle, Bernie; Steinberg, Benjamin A.; Shah, Rashmee U.; Fang, James C.; Spertus, John A.; Stehlik, Josef

doi:10.1001/jamacardio.2021.0939

Cited by 30 publications

(18 citation statements)

References 16 publications

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“…Several studies have confirmed recovered or improved ejection fraction as an independent group associated with reduced adverse events, such as cardiovascular death and hospitalization, compared with both HFrEF and HFpEF patients ( 5 , 6 ). In addition to the effect on mortality and hospitalization outcomes, Peter Wohlfahrt et al confirmed that HFrecEF significantly improved the quality of life in patients with heart failure ( 9 ). However, the prognostic effect of recovered ejection fraction was inconsistent or even non-significant ( 10 , 12 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous HFrEF patients who developed HFimpEF during the follow-up visit were demonstrated with not only a better prognosis but also a significant improvement in health-related quality of life ( 6 , 9 ). However, different conclusions appeared in Joan Carles Trullàs's study, which showed that the risk of death between HFimpEF and HFrEF groups was not statistically significant ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Ling

Guo

et al. 2021

Front. Cardiovasc. Med.

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Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Ling

Guo

et al. 2021

Front. Cardiovasc. Med.

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“…baseline LVEF of ≤40% that improved to LVEF ≥50% during the study period). 22 24 Similarly, in a large study of patients with and without HF in the National Echo Database Australia, both positive and negative changes in LVEF over time were associated with increased or decreased all-cause mortality, respectively. 15 To our knowledge, no prior studies used multicentre, observational data to specifically evaluate the association between observed improvements in LVEF and in health status in large numbers of patients.…”

Section: Discussionmentioning

confidence: 97%

“…For example, investigators at the University of Utah compared changes in KCCQ‐12 scores over time for patients with HFrEF or HF with preserved ejection fraction (HFpEF) with no improvement in LVEF to changes in KCCQ‐12 in patients that had HF with recovered ejection fraction (i.e. baseline LVEF of ≤40% that improved to LVEF ≥50% during the study period) 22 . Among 35 patients that had HF with recovered ejection fraction, the mean change in KCCQ‐12 score was 15.3 (standard deviation 19.9) compared with 5.8 (20.2) in the HFrEF group and 2.2 (19.8) in the HFpEF group ( p =0.009).…”

Section: Discussionmentioning

confidence: 99%

“…Data from routine practice examining the association between improvements in LVEF and outcomes are more limited. 15,[20][21][22][23][24] For example, investigators at the University of Utah compared changes in KCCQ-12 scores over time for patients with HFrEF or HF with preserved ejection fraction (HFpEF) with no improvement in LVEF to changes in KCCQ-12 in patients that had HF with recovered ejection fraction (i.e. baseline LVEF of ≤40% that improved to LVEF ≥50% during the study period).…”

Section: Discussionmentioning

confidence: 99%

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The association of improvement in left ventricular ejection fraction with outcomes in patients with heart failure with reduced ejection fraction: data from CHAMP‐HF

DeVore

Hellkamp

Thomas

et al. 2022

European J of Heart Fail

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Aims We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. Methods and results CHAMP‐HF was a registry of outpatients with heart failure (HF) and LVEF ≤40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire‐12 (KCCQ‐12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (≥10%) over time and concurrent changes in KCCQ‐12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th–75th percentile 58–75), 29% female, median duration of HF 2.7 years (0.6–6.8), and median baseline LVEF 30% (23–35). Of the study participants, 689 (33%) had a ≥10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ‐12 overall summary score compared with participants without an LVEF improvement (+7.6 vs. +3.5, adjusted effect estimate +4.01 [95% confidence interval CI 2.3–5.7]). Similarly, subsequent all‐cause death or HF hospitalization occurred in 12% in the LVEF improvement group versus 25% in the group without an LVEF improvement (adjusted hazard ratio 0.50, 95% confidence interval 0.41–0.61). Conclusion In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF.

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Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

et al. 2022

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Aims The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10‐point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. Methods We reviewed data from a prospective registry of real‐world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all‐cause death or HF hospitalization. Results Baseline and 1‐year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (−16.0 ± 23.8 vs. −11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non‐HFimpEF group (P = 0.001). The 1‐year QoL was similar between groups (P = 0.50). The 1‐year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01–1.03, P = 0.006). In contrast, the QoL improvement (with a cut‐off ≥5 points) was not independently associated with the composite outcome. Conclusions Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1‐year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1‐year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.

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Quality of Life in Patients With Heart Failure With Recovered Ejection Fraction

Cited by 30 publications

References 16 publications

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

The association of improvement in left ventricular ejection fraction with outcomes in patients with heart failure with reduced ejection fraction: data from CHAMP‐HF

Quality of life in patients with heart failure and improved ejection fraction: one‐year changes and prognosis

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