Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction

Chan Soon Park, Jin Joo Park, Alexandre Mebazaa, Il Young Oh, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Kye Hun Kim, Byungsu Yoo, seokmin kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article numbere011077
JournalJournal of the American Heart Association
Volume8
Issue number6
DOIs
Publication statusPublished - 2019 Mar 19

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Treatment Failure
Heart Failure
Stroke Volume
Echocardiography
Phenotype
Mortality
Mineralocorticoid Receptor Antagonists
Korea
Atrial Fibrillation
Myocardial Ischemia
Registries
Diabetes Mellitus
Hospitalization
Odds Ratio
Clinical Trials
Hypertension

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, C. S., Park, J. J., Mebazaa, A., Oh, I. Y., Park, H. A., Cho, H. J., ... Choi, D. J. (2019). Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction. Journal of the American Heart Association, 8(6), [e011077]. https://doi.org/10.1161/JAHA.118.011077
Park, Chan Soon ; Park, Jin Joo ; Mebazaa, Alexandre ; Oh, Il Young ; Park, Hyun Ah ; Cho, Hyun Jai ; Lee, Hae Young ; Kim, Kye Hun ; Yoo, Byungsu ; kang, seokmin ; Baek, Sang Hong ; Jeon, Eun Seok ; Kim, Jae Joong ; Cho, Myeong Chan ; Chae, Shung Chull ; Oh, Byung Hee ; Choi, Dong Ju. / Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 6.
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abstract = "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.",
author = "Park, {Chan Soon} and Park, {Jin Joo} and Alexandre Mebazaa and Oh, {Il Young} and Park, {Hyun Ah} and Cho, {Hyun Jai} and Lee, {Hae Young} and Kim, {Kye Hun} and Byungsu Yoo and seokmin kang and Baek, {Sang Hong} and Jeon, {Eun Seok} and Kim, {Jae Joong} and Cho, {Myeong Chan} and Chae, {Shung Chull} and Oh, {Byung Hee} and Choi, {Dong Ju}",
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Park, CS, Park, JJ, Mebazaa, A, Oh, IY, Park, HA, Cho, HJ, Lee, HY, Kim, KH, Yoo, B, kang, S, Baek, SH, Jeon, ES, Kim, JJ, Cho, MC, Chae, SC, Oh, BH & Choi, DJ 2019, 'Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction', Journal of the American Heart Association, vol. 8, no. 6, e011077. https://doi.org/10.1161/JAHA.118.011077

Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction. / Park, Chan Soon; Park, Jin Joo; Mebazaa, Alexandre; Oh, Il Young; Park, Hyun Ah; Cho, Hyun Jai; Lee, Hae Young; Kim, Kye Hun; Yoo, Byungsu; kang, seokmin; Baek, Sang Hong; Jeon, Eun Seok; Kim, Jae Joong; Cho, Myeong Chan; Chae, Shung Chull; Oh, Byung Hee; Choi, Dong Ju.

In: Journal of the American Heart Association, Vol. 8, No. 6, e011077, 19.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction

AU - Park, Chan Soon

AU - Park, Jin Joo

AU - Mebazaa, Alexandre

AU - Oh, Il Young

AU - Park, Hyun Ah

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Kim, Kye Hun

AU - Yoo, Byungsu

AU - kang, seokmin

AU - Baek, Sang Hong

AU - Jeon, Eun Seok

AU - Kim, Jae Joong

AU - Cho, Myeong Chan

AU - Chae, Shung Chull

AU - Oh, Byung Hee

AU - Choi, Dong Ju

PY - 2019/3/19

Y1 - 2019/3/19

N2 - 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.

AB - 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.

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