Outcomes in Heart Failure With Improved Ejection Fraction Following Implantable Cardioverter-Defibrillator Placement
Michael N Zarrella1, Carolina Borz-Baba1, Dorothy Wakefield2
1Internal Medicine, St. Mary's Hospital, Waterbury, USA.
Cureus
|July 7, 2025
Summary
Patients with heart failure who improved ejection fraction (HFimpEF) after cardiac device implantation show reduced hospitalizations. Lower brain natriuretic peptide levels predict better outcomes and decreased mortality in these patients.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Research
Background:
- Limited data exist on outcomes for heart failure with improved ejection fraction (HFimpEF) post-cardiac device implantation (ICD/CRT).
- This study uses the 2022 AHA/ACC definition of HFimpEF to assess contemporary outcomes.
- Focus on non-tertiary hospital settings for device implantation.
Purpose of the Study:
- To evaluate hospitalization and mortality rates in patients with HFimpEF after ICD or CRT implantation.
- To compare outcomes between HFimpEF and persistent heart failure with reduced ejection fraction (HFrEF) populations.
- To identify predictors of improved ejection fraction and mortality.
Main Methods:
- Retrospective analysis of 54 patients receiving ICD or CRT for primary prevention (2019-2022).
- Ejection fraction (EF) improvement assessed via echocardiogram ≥6 months post-implantation.
- Outcomes measured: 1-year and overall hospitalization/mortality rates; brain natriuretic peptide (BNP) levels.
Main Results:
- HFimpEF patients had significantly lower 1-year (22.2% vs. 48.2%) and overall (59.3% vs. 85.19%) hospitalization rates compared to HFrEF.
- Heart failure was the primary cause (50%) of cardiac-related hospitalizations.
- Lower BNP levels predicted improved EF (p < 0.01) and decreased mortality (p < 0.01).
Conclusions:
- Patients achieving myocardial recovery (HFimpEF) post-ICD/CRT have better prognoses than those with persistent HFrEF.
- Uncontrolled heart failure remains a key driver of hospitalization.
- Standardized outpatient summaries with scheduled BNP assessment may improve HFimpEF care cost-effectively.
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