Heart failure & cardiomyopathiesCohort study
Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure With Improved Ejection Fraction
- Retrospective cohort study
- multisite integrated health care delivery system
Authors' conclusion
A significant percentage of patients with HFrEF experience improvement in ejection fraction, transitioning to HFimpEF, yet remain at significant clinical risk.
Study context
- Population
- Patients with incident Heart Failure with Reduced Ejection Fraction (HFrEF), Kaiser Permanente Northern California, January 2013–December 2022
- Participants
- 28,292 patients
- Exposure
- Heart failure with improved ejection fraction (HFimpEF) vs persistent HFrEF
- HFimpEFn = 8,656
Main finding
As reported in the abstract
Worsening HF and death
HFimpEF
17.4 per 100 person-years (95% CI: 16.9-18.0)
Worsening HF · Death 5.7 per 100 person-years (95% CI: 5.4-6.0)
Persistent HFrEF
34.1 per 100 person-years (95% CI: 33.5-34.6)
Worsening HF · Death 11.0 per 100 person-years (95% CI: 10.7-11.3)
HFimpEF vs Persistent HFrEFHazard ratio (95% CI)
worsening HF
0.58(0.55–0.61)
death
0.52(0.49–0.56)
Observational data: associations, not effects.
Further findings
- Incidence of HFimpEF within 12 months
- 30.6% · 8,656 of 8,656
Guideline-directed medical therapy (GDMT) use after incident HFimpEF
- Use of GDMT marginally decreased in most medication categories after incident HFimpEF
GDMT withdrawal
- Withdrawal of GDMT modestly associated with greater clinical risk
Original publication
Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure With Improved Ejection Fraction. J Am Coll Cardiol. Published 5 August 2025. doi:10.1016/j.jacc.2025.05.040
Summarised from the published abstract; every number is checked against it