American heart journal · 2026
Incidence, medical therapy, and outcomes in heart failure with improved ejection fraction across guideline definitions.
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Agharahmanian Arash, Min Kyung H, Go Alan S, Parikh Rishi V, Ambrosy Andrew P, Tan Thida C, Svetlichnaya Jana, Vardeny Orly, Solomon Scott D, Inciardi Riccardo M, Vaduganathan Muthiah, Sandhu Alexander T, Ku Ivy A, Bhatt Ankeet S
Аннотация
PURPOSE: To assess the incidence of heart failure with improved ejection fraction (HFimpEF) across guideline definitions (ACC/AHA, ESC, HFA/HFSA/JHFS) and to evaluate differences in guideline directed medical therapy (GDMT) utilization and rates of heart failure hospitalization (HF) or death among patients meeting each criterion.
METHODS: We identified patients with incident heart failure with reduced ejection fraction (HFrEF) between January 2013 and December 2024 within the Kaiser Permanente Northern California (KPNC) healthcare system. HFimpEF was defined with a follow-up LVEF that satisfied at least one of three definitions: ACC/AHA (EF > 40%), HFA/HFSA/JHFS (EF > 40% with ≥10-point increase), and ESC (EF ≥ 50%). We assessed (1) HFimpEF incidence, (2) the one-year post-diagnosis mutually exclusive incidences of HF hospitalization or death, and (3) GDMT use across each definition.
RESULTS: Of 37,443 patients with newly diagnosed HFrEF, 15,030 (40.1%) were classified as HFimpEF based on the ACC/AHA definition, 13,253 (35.4%) based on the HFA/HFSA/JHFS definition, and 10,304 (27.5%) based on the ESC definition. Mutually exclusive cumulative incidences of HF hospitalization or death at 10 years after HFimpEF were higher among patients whose EF improvement met the ACC/AHA definition but did not meet the other two (Figure 2, log-rank p<0.001).
CONCLUSION: Based on definition used, the prevalence of HFimpEF ranges widely from 28-40%. Irrespective of definition, patients with HFimpEF remain at residual risk for clinical deterioration and share a similar prognosis despite improvement in EF. These data highlight the persistence of heart failure rather than true recovery; trials to optimize available and new HF treatments are warranted.
METHODS: We identified patients with incident heart failure with reduced ejection fraction (HFrEF) between January 2013 and December 2024 within the Kaiser Permanente Northern California (KPNC) healthcare system. HFimpEF was defined with a follow-up LVEF that satisfied at least one of three definitions: ACC/AHA (EF > 40%), HFA/HFSA/JHFS (EF > 40% with ≥10-point increase), and ESC (EF ≥ 50%). We assessed (1) HFimpEF incidence, (2) the one-year post-diagnosis mutually exclusive incidences of HF hospitalization or death, and (3) GDMT use across each definition.
RESULTS: Of 37,443 patients with newly diagnosed HFrEF, 15,030 (40.1%) were classified as HFimpEF based on the ACC/AHA definition, 13,253 (35.4%) based on the HFA/HFSA/JHFS definition, and 10,304 (27.5%) based on the ESC definition. Mutually exclusive cumulative incidences of HF hospitalization or death at 10 years after HFimpEF were higher among patients whose EF improvement met the ACC/AHA definition but did not meet the other two (Figure 2, log-rank p<0.001).
CONCLUSION: Based on definition used, the prevalence of HFimpEF ranges widely from 28-40%. Irrespective of definition, patients with HFimpEF remain at residual risk for clinical deterioration and share a similar prognosis despite improvement in EF. These data highlight the persistence of heart failure rather than true recovery; trials to optimize available and new HF treatments are warranted.