Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction
Background Many patients with heart failure (HF) with reduced ejection fraction (HFrEF) experience improvement or recovery of left ventricular ejection fraction (LVEF). Data on clinical characteristics, outcomes, and medical therapy in patients with HF with improved ejection fraction (HFiEF) are sca...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011077 |
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| author | Chan Soon Park Jin Joo Park Alexandre Mebazaa Il‐Young Oh Hyun‐Ah Park Hyun‐Jai Cho Hae‐Young Lee Kye Hun Kim Byung‐Su Yoo Seok‐Min Kang Sang Hong Baek Eun‐Seok Jeon Jae‐Joong Kim Myeong‐Chan Cho Shung Chull Chae Byung‐Hee Oh Dong‐Ju Choi |
| author_facet | Chan Soon Park Jin Joo Park Alexandre Mebazaa Il‐Young Oh Hyun‐Ah Park Hyun‐Jai Cho Hae‐Young Lee Kye Hun Kim Byung‐Su Yoo Seok‐Min Kang Sang Hong Baek Eun‐Seok Jeon Jae‐Joong Kim Myeong‐Chan Cho Shung Chull Chae Byung‐Hee Oh Dong‐Ju Choi |
| author_sort | Chan Soon Park |
| collection | DOAJ |
| description | Background Many patients with heart failure (HF) with reduced ejection fraction (HFrEF) experience improvement or recovery of left ventricular ejection fraction (LVEF). Data on clinical characteristics, outcomes, and medical therapy in patients with HF with improved ejection fraction (HFiEF) are scarce. Methods and Results Of 5625 consecutive patients hospitalized for acute HF in the KorAHF (Registry [Prospective Cohort] for Heart Failure in Korea) study, 5103 patients had baseline echocardiography and 2302 patients had follow‐up echocardiography at 12 months. HF phenotypes were defined as persistent HFrEF (LVEF ≤40% at baseline and at 1‐year follow‐up), HFiEF (LVEF ≤40% at baseline and improved up to 40% at 1‐year follow‐up), HF with midrange ejection fraction (LVEF between 40% and <50%), and HF with preserved ejection fraction (LVEF ≥50%). The primary outcome was 4‐year all‐cause mortality from the time of HFiEF diagnosis. Among 1509 HFrEF patients who had echocardiography 1 year after index hospitalization, 720 (31.3%) were diagnosed as having HFiEF. Younger age, female sex, de novo HF, hypertension, atrial fibrillation, and β‐blocker use were positive predictors and diabetes mellitus and ischemic heart disease were negative predictors of HFiEF. During 4‐year follow‐up, patients with HFiEF showed lower mortality than those with persistent HFrEF in univariate, multivariate, and propensity‐score–matched analyses. β‐Blockers, but not renin–angiotensin system inhibitors or mineralocorticoid receptor antagonists, were associated with a reduced all‐cause mortality risk (hazard ratio: 0.59; 95% CI, 0.40–0.87; P=0.007). Benefits for outcome seemed similar among patients receiving low‐ or high‐dose β‐blockers (log‐rank, P=0.304). Conclusions HFiEF is a distinct HF phenotype with better clinical outcomes than other phenotypes. The use of β‐blockers may be beneficial for these patients. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843. |
| first_indexed | 2024-12-22T22:59:43Z |
| format | Article |
| id | doaj.art-8d3c60a1dce7412da5ba2a2baa3e9740 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:59:43Z |
| publishDate | 2019-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8d3c60a1dce7412da5ba2a2baa3e97402022-12-21T18:09:43ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-03-018610.1161/JAHA.118.011077Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection FractionChan Soon Park0Jin Joo Park1Alexandre Mebazaa2Il‐Young Oh3Hyun‐Ah Park4Hyun‐Jai Cho5Hae‐Young Lee6Kye Hun Kim7Byung‐Su Yoo8Seok‐Min Kang9Sang Hong Baek10Eun‐Seok Jeon11Jae‐Joong Kim12Myeong‐Chan Cho13Shung Chull Chae14Byung‐Hee Oh15Dong‐Ju Choi16Graduate School of Medical Science and Engineering Korea Advanced Institute of Science and Technology Daejeon Republic of KoreaCardiovascular Center Division of Cardiology Seoul National University Bundang Hospital Seongnam Republic of KoreaDepartment of Anesthesiology and Intensive Care Medicine Hôpitaux Universitaires Saint Louis Lariboisière APHP Paris FranceCardiovascular Center Division of Cardiology Seoul National University Bundang Hospital Seongnam Republic of KoreaDepartment of Family Medicine Inje University Seoul Paik Hospital Seoul Republic of KoreaDepartment of Internal Medicine Seoul National University Hospital Seoul Republic of KoreaDepartment of Internal Medicine Seoul National University Hospital Seoul Republic of KoreaHeart Research Center Chonnam National University Gwangju Republic of KoreaDepartment of Internal Medicine Yonsei University Wonju College of Medicine Wonju Republic of KoreaDepartment of Internal Medicine Yonsei University College of Medicine Seoul Republic of KoreaDepartment of Internal Medicine Catholic University of Korea Seoul Republic of KoreaDepartment of Internal Medicine Sungkyunkwan University College of Medicine Seoul Republic of KoreaDivision of Cardiology Asan Medical Center Seoul Republic of KoreaDepartment of Internal Medicine Chungbuk National University College of Medicine Cheongju Republic of KoreaDepartment of Internal Medicine Kyungpook National University College of Medicine Daegu Republic of KoreaDepartment of Internal Medicine Mediplex Sejong Hospital Incheon Republic of KoreaCardiovascular Center Division of Cardiology Seoul National University Bundang Hospital Seongnam Republic of KoreaBackground Many patients with heart failure (HF) with reduced ejection fraction (HFrEF) experience improvement or recovery of left ventricular ejection fraction (LVEF). Data on clinical characteristics, outcomes, and medical therapy in patients with HF with improved ejection fraction (HFiEF) are scarce. Methods and Results Of 5625 consecutive patients hospitalized for acute HF in the KorAHF (Registry [Prospective Cohort] for Heart Failure in Korea) study, 5103 patients had baseline echocardiography and 2302 patients had follow‐up echocardiography at 12 months. HF phenotypes were defined as persistent HFrEF (LVEF ≤40% at baseline and at 1‐year follow‐up), HFiEF (LVEF ≤40% at baseline and improved up to 40% at 1‐year follow‐up), HF with midrange ejection fraction (LVEF between 40% and <50%), and HF with preserved ejection fraction (LVEF ≥50%). The primary outcome was 4‐year all‐cause mortality from the time of HFiEF diagnosis. Among 1509 HFrEF patients who had echocardiography 1 year after index hospitalization, 720 (31.3%) were diagnosed as having HFiEF. Younger age, female sex, de novo HF, hypertension, atrial fibrillation, and β‐blocker use were positive predictors and diabetes mellitus and ischemic heart disease were negative predictors of HFiEF. During 4‐year follow‐up, patients with HFiEF showed lower mortality than those with persistent HFrEF in univariate, multivariate, and propensity‐score–matched analyses. β‐Blockers, but not renin–angiotensin system inhibitors or mineralocorticoid receptor antagonists, were associated with a reduced all‐cause mortality risk (hazard ratio: 0.59; 95% CI, 0.40–0.87; P=0.007). Benefits for outcome seemed similar among patients receiving low‐ or high‐dose β‐blockers (log‐rank, P=0.304). Conclusions HFiEF is a distinct HF phenotype with better clinical outcomes than other phenotypes. The use of β‐blockers may be beneficial for these patients. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.https://www.ahajournals.org/doi/10.1161/JAHA.118.011077β‐blockersheart failureimproved ejection fractionmortality |
| spellingShingle | Chan Soon Park Jin Joo Park Alexandre Mebazaa Il‐Young Oh Hyun‐Ah Park Hyun‐Jai Cho Hae‐Young Lee Kye Hun Kim Byung‐Su Yoo Seok‐Min Kang Sang Hong Baek Eun‐Seok Jeon Jae‐Joong Kim Myeong‐Chan Cho Shung Chull Chae Byung‐Hee Oh Dong‐Ju Choi Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease β‐blockers heart failure improved ejection fraction mortality |
| title | Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction |
| title_full | Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction |
| title_fullStr | Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction |
| title_full_unstemmed | Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction |
| title_short | Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction |
| title_sort | characteristics outcomes and treatment of heart failure with improved ejection fraction |
| topic | β‐blockers heart failure improved ejection fraction mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011077 |
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