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Updated: Sep 13, 2025
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure With Improved Ejection Fraction
Kyung H Min1, Alan S Go2, Keane Lee3
1Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
Journal of the American College of Cardiology
|July 30, 2025
Summary
A significant portion of heart failure with reduced ejection fraction patients improve ejection fraction (HFimpEF) but still face clinical risks. Continued guideline-directed medical therapy (GDMT) is crucial for managing HFimpEF outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Heart failure with improved ejection fraction (HFimpEF) prevalence is rising with new treatments for heart failure with reduced ejection fraction (HFrEF).
- Limited contemporary data exist on HFimpEF epidemiology, management, and outcomes.
- This study addresses the knowledge gap regarding HFimpEF in a large healthcare system.
Purpose of the Study:
- To describe the epidemiology of HFimpEF.
- To analyze guideline-directed medical therapy (GDMT) use in HFimpEF.
- To evaluate clinical outcomes for patients with HFimpEF.
Main Methods:
- Identified incident heart failure with reduced ejection fraction (HFrEF) cases from 2013-2022 in a large integrated health system.
- Defined HFimpEF as HFrEF with ejection fraction >40% and >10% absolute improvement within 12 months.
- Compared worsening heart failure events and death rates between HFimpEF and persistent HFrEF groups, analyzing GDMT use.
Main Results:
- 30.6% of 28,292 incident HFrEF patients developed HFimpEF within 12 months.
- Guideline-directed medical therapy (GDMT) use slightly decreased post-HFimpEF diagnosis.
- HFimpEF patients had significantly lower rates of worsening heart failure (17.4 vs 34.1 per 100 person-years) and death (5.7 vs 11.0 per 100 person-years) compared to persistent HFrEF.
Conclusions:
- A substantial percentage of HFrEF patients transition to HFimpEF but remain at considerable clinical risk.
- Withdrawal of GDMT is associated with increased clinical risk in HFimpEF.
- Further research is needed on sustained GDMT adherence and optimization for HFimpEF outcomes.
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