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Updated: Jul 16, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Clinical, Echocardiographic, and Longitudinal Characteristics Associated with Heart Failure with Improved Ejection
Insights
Nearly 40% of heart failure with reduced ejection fraction (HFrEF) patients improved to heart failure with improved ejection fraction (HFimpEF). Sex, race, comorbidities, and specific medical data predict this improvement, offering insights for better patient care.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Outcomes
Background:
- Heart failure with improved ejection fraction (HFimpEF) demonstrates better patient outcomes compared to heart failure with reduced ejection fraction (HFrEF).
- Factors influencing the transition to HFimpEF remain incompletely understood.
- This study investigated clinical and longitudinal characteristics associated with the development of HFimpEF in a HFrEF cohort.
Approach:
- A retrospective cohort study was conducted on 1307 patients with HFrEF between 2014 and 2022.
- Patients were identified using ICD codes, echocardiographic data, and natriuretic peptide levels.
- Cox proportional hazards and mixed effects models analyzed the primary endpoints of HFimpEF development and mortality.
Key Points:
- 39% of HFrEF patients transitioned to HFimpEF, with 50% achieving this within 12 months.
- Multivariate analysis revealed sex, race, comorbidities, echocardiographic parameters, and natriuretic peptide levels as significant predictors of HFimpEF.
- The HFimpEF group exhibited significantly better survival rates than the persistent HFrEF group.
Conclusions:
- A substantial proportion of HFrEF patients can transition to HFimpEF, indicating potential for recovery.
- Predictive factors identified can aid in identifying patients at risk for persistent HFrEF or those likely to improve.
- This predictive model can inform targeted interventions to enhance quality of care for heart failure patients.
Background:
Heart failure (HF) with improved ejection fraction (HFimpEF) has better outcomes than HF with reduced ejection fraction (HFrEF). However, factors contributing to HFimpEF remain unclear. This study aimed to evaluate clinical and longitudinal characteristics associated with subsequent HFimpEF.
Methods:
This was a single-center retrospective HFrEF cohort study. Data were collected from 2014 to 2022. Patients with HFrEF were identified using ICD codes, echocardiographic data, and natriuretic peptide levels. The main endpoints were HFimpEF (defined as ejection fraction >40% at ≥3 months with ≥10% increase) and mortality. Cox proportional hazards and mixed effects models were used for analyses.
Results:
The study included 1307 HFrEF patients with a median follow-up of 16.3 months (IQR 8.0-30.6). The median age was 65 years; 68% were male while 57% were white. On follow-up, 39% (n=506) developed HFimpEF, while 61% (n=801) had persistent HFrEF. A multivariate Cox regression model identified sex, race comorbidities, echocardiographic, and natriuretic peptide as significant covariates of HFimpEF ( p <0.05). The HFimpEF group had better survival compared to the persistent HFrEF group ( p <0.001). Echocardiographic and laboratory trajectories differed between groups.
Conclusion:
In this HFrEF cohort, 39% transitioned to HFimpEF and approximately 50% met the definition within the first 12 months. In a HFimpEF model, sex, comorbidities, echocardiographic parameters, and natriuretic peptide were associated with subsequent HFimpEF. The model has the potential to identify patients at risk of subsequent persistent or improved HFrEF, thus informing the design and implementation of targeted quality-of-care improvement interventions.
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