Outcomes may be good after ejection fraction recovery
medwireNews: Recovery from a reduced ejection fraction (EF) appears to be a predictor of good outcomes in patients with heart failure (HF), a retrospective analysis shows.
In the single-centre study, 350 HF patients with an EF greater than 40%, having previously been lower, had a 3-year mortality rate of just 4.8%, after adjustment for age and gender. By contrast, rates in 466 patients with a preserved EF and 1350 with a reduced EF were 13.2% and 16.3%, respectively.
Mortality rates did not differ between the three groups during the first year of follow-up, with the survival benefit among patients with a recovered EF seen only during the second and third years. After accounting for further confounders such as body mass index, blood pressure and comorbidities, patients with a recovered EF had a significant 65% risk reduction during this latter period.
Relative to patients with a reduced EF, those with a recovered EF also had a significant 38% reduction in the rate of hospitalisation for any cause and 66% and 74% reductions for cardiovascular and heart failure hospitalisation rates, respectively. Patients with a preserved EF had a reduced rate of cardiovascular and heart failure hospitalisation, but not of all-cause hospitalisation relative to those with a reduced EF.
The overall findings were similar with 50% as the cutoff to indicate a preserved EF, say Andreas Kalogeropoulos (Emory University School of Medicine, Atlanta, Georgia, USA) and study co-authors in JAMA Cardiology.
In an accompanying editorial, Jane Wilcox and Clyde Yancy (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) note the potential role of survival bias and therefore “interpret the data with interest but not yet with conviction.”
But regardless of patient survival, they highlight the “inescapable” conclusion that some patients with HF do recover from having a reduced EF.
The median EF was 50% among study participants with recovered EF, and their pre-recovery EF was 25%, with recovery occurring in around 3 years in the majority of these patients. Wilcox and Yancy comment that the duration of HF was either not known or not reported.
“Indeed, HF duration may be viewed as a surrogate of chronic adverse myocardial structural and molecular remodeling beyond which there is no potential for repair”, they write.
The editorialists observe that current understanding of EF recovery is very limited and mostly gained from patients with ventricular assist devices. “Now is the time to recognize recovery as a clinical reality for patients with HF [and reduced] EF and to begin a deliberate pursuit of the underlying mechanisms and future clinical considerations”, they conclude.
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