title: Recovered heart failure with reduced ejection fraction and outcomes: a prospective study.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Díez-López
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Domingo
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zamora
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moliner
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Santesmases
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Troya
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayés-Genís
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Heart failure with mid-range ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Left ventricular ejection fraction; Recovered