title: Factors associated with improvement in ejection fraction in clinical practice among patients with heart failure: findings from IMPROVE HF.
abstract: BACKGROUND
  Available data suggest that improvement in left ventricular ejection fraction (LVEF) is a major predictor of improved survival in heart failure (HF). Although certain factors are associated with improvements in LVEF in select patients with HF enrolled in clinical trials, relatively little is known about such factors among patients in clinical practice. This study evaluated changes in LVEF and associated factors in outpatients with systolic HF or post-myocardial infarction with reduced LVEF during 24 months of follow-up.
  
  
  METHODS
  IMPROVE HF is a prospective evaluation of a practice-based performance improvement intervention implemented at outpatient cardiology/multispecialty practices to increase use of guideline-recommended care for eligible patients. Data were analyzed by patient groups based on absolute improvement in LVEF (<0%, 0-≤10%, and >10%) from baseline to 24 months and by change in LVEF as a continuous variable.
  
  
  RESULTS
  A total of 3,994 patients from 155 of 167 practices were eligible for analysis. The overall mean LVEF increased from 25.8% at baseline to 32.3% (+6.4%) at 24 months (P < .001), and 28.6% of patients had a >10% improvement in ejection fraction (from 24.5% to 46.2%, 92% relative improvement). Age, race, and practice setting were similar between the 3 LVEF improvement groups. Multivariate analysis revealed female sex, no prior myocardial infarction, nonischemic HF etiology, and no digoxin use were associated with >10% improvement in LVEF.
  
  
  CONCLUSIONS
  Among patients with HF receiving care in cardiology/multispecialty practices participating in a performance measure intervention, surviving, and having repeat LVEF assessment, close to one third of patients had a >10% improvement in LVEF at 24 months. These findings indicate that HF is not always a progressive disease and that differentiation of the heterogeneous HF phenotypes may set the stage for future research and therapeutic targets.
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Wilcox
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Anne B
authors.initials: AB
authors.lastname: Curtis
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
authors.forename: Patches Johnson
authors.initials: PJ
authors.lastname: Inge
authors.forename: Mark L
authors.initials: ML
authors.lastname: McBride
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Dwight
authors.initials: D
authors.lastname: Reynolds
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013318:Stroke Volume; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000628:therapy*