Heart failure & cardiomyopathiesCohort study
Therapy duration and improvement of ventricular function in de novo heart failure: the Heart Failure Optimization study
- Prospective registry and cohort study
- multicentre
- 68 sites
- registry phase 3 months then study phase up to 1 year
Authors' conclusion
Continuous optimization of guideline-recommended medical therapy for at least 180 days in HFrEF is associated with additional LVEF improvement > 35%, allowing for better decision-making regarding preventive implantable cardioverter-defibrillator therapy.
Study context
- Population
- Patients with de novo heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤ 35% prescribed a wearable cardioverter-defibrillator, 2017–2022entered study phase
- Participants
- 598 patients
- Outcome
- LVEF improvement > 35% after guideline-recommended medical therapy initiation; percentage of target dose reached
- Follow-up
- Days 90 and 180
Main finding
As reported in the abstract
LVEF improvement > 35% at Day 90
46% (95% CI 41%-50%)
LVEF improvement > 35% by Day 180 among those with persistently low LVEF at Day 90
46% (95% CI 40%-52%)
Total LVEF improvement > 35% by Day 180
68% (95% CI 63%-72%)
Significant increase in dosage of beta-blockers, renin-angiotensin system inhibitors and MRA during first 180 days
P < .001
Observational data: associations, not effects.
Further findings
LVEF improvement > 35% at 360 days
- Improvement > 35% in 392 patients followed for 360 days
- 77% (95% CI 72%-81%)
Safety
Sustained ventricular tachyarrhythmias in WCD carriers · Until Day 90
- Sustained ventricular tachyarrhythmias until Day 90
- 24 (1.8%)
- No sustained ventricular tachyarrhythmia after 90 days
Original publication
Summarised from the published abstract; every number is checked against it