Min Kyung H, Go Alan S, Lee Keane, Parikh Rishi V, Horiuchi Kate M, Ambrosy Andrew P, Tan Thida C, Srikanth Kishan, Hamilton Steven A, Svetlichnaya Jana, Solomon Scott D, Inciardi Riccardo M, Vardeny Orly, Vasti Elena, Sandhu Alexander T, Ku Ivy A, Adatya Sirtaz, Bhatt Ankeet S
Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
J Am Coll Cardiol. 2025 Aug 5;86(5):338-350. doi: 10.1016/j.jacc.2025.05.040.
The prevalence of heart failure with improved ejection fraction (HFimpEF) is anticipated to increase with the availability and implementation of novel pharmacotherapy for heart failure with reduced ejection fraction (HFrEF). However, there are limited data on contemporary epidemiology, management, and outcomes for this clinical entity.
The aim of this study was to describe epidemiology, guideline-directed medical therapy (GDMT), and outcomes among patients with HFimpEF across a large, diverse, multisite integrated health care delivery system.
Patients who were diagnosed with incident HFrEF between January 2013 and December 2022 across the Kaiser Permanente Northern California integrated health care delivery system were identified. Rates of incident HFimpEF, defined as HFrEF with a follow-up ejection fraction >40% and with >10% absolute left ventricular ejection fraction improvement within 12 months of incident HFrEF diagnosis, were identified. GDMT was examined at the time of incident HFrEF and HFimpEF and in the year following HFimpEF. Rates of worsening heart failure events and death were examined and compared among those with HFimpEF vs persistent HFrEF.
In total, 28,292 patients with newly diagnosed HFrEF (mean left ventricular ejection fraction 31.1% ± 7.4%) were identified, of whom 8,656 (30.6%) experienced HFimpEF within 12 months. Use of GDMT marginally decreased in most medication categories after incident HFimpEF during the study period. Rates of worsening heart failure were 17.4 per 100 person-years (95% CI: 16.9-18.0 per 100 person-years) among patients with HFimpEF vs 34.1 per 100 person-years (95% CI: 33.5-34.6 per 100 person-years) among patients with persistent HFrEF (HR: 0.58; 95% CI: 0.55-0.61 per 100 person-years). Rates of death were 5.7 per 100 person-years (95% CI: 5.4-6.0 per 100 person-years) and 11.0 per 100 person-years (95% CI: 10.7-11.3 per 100 person-years) among patients with HFimpEF and those with persistent HFrEF, respectively (HR: 0.52; 95% CI: 0.49-0.56). Withdrawal of GDMT was modestly associated with greater clinical risk.
A significant percentage of patients with HFrEF experience improvement in ejection fraction, transitioning to HFimpEF, yet remain at significant clinical risk. Further research is needed to evaluate the impact of sustained GDMT adherence and therapeutic optimization on outcomes in patients with HFimpEF.
随着射血分数降低的心力衰竭（HFrEF）新型药物治疗的出现和应用，射血分数改善的心力衰竭（HFimpEF）患病率预计将会增加。然而，关于这一临床实体的当代流行病学、管理及预后的数据有限。
本研究旨在描述在一个大型、多样化、多地点的综合医疗服务体系中HFimpEF患者的流行病学、指南指导的药物治疗（GDMT）及预后情况。
确定2013年1月至2022年12月期间在北加利福尼亚永久医疗集团综合医疗服务体系中被诊断为新发HFrEF的患者。确定HFimpEF的发病率，定义为HFrEF患者在HFrEF诊断后12个月内随访射血分数>40%且左心室射血分数绝对值改善>10%。在新发HFrEF和HFimpEF时以及HFimpEF后的一年内检查GDMT情况。比较HFimpEF患者与持续性HFrEF患者心力衰竭恶化事件和死亡的发生率。
共确定28292例新诊断的HFrEF患者（平均左心室射血分数31.1%±7.4%），其中8656例（30.6%）在12个月内发生HFimpEF。在研究期间，HFimpEF发生后大多数药物类别的GDMT使用略有减少。HFimpEF患者心力衰竭恶化率为每100人年17.4例（95%CI：每100人年16.9 - 18.0例），而持续性HFrEF患者为每100人年34.1例（95%CI：每100人年33.5 - 34.6例）（HR：0.58；95%CI：每100人年0.55 - 0.61）。HFimpEF患者和持续性HFrEF患者的死亡率分别为每100人年5.7例（95%CI：每100人年5.4 - 6.0例）和每100人年11.0例（95%CI：每100人年10.7 - 11.3例）（HR：0.52；95%CI：0.49 - 0.56）。停用GDMT与更高的临床风险有适度关联。
相当比例的HFrEF患者射血分数得到改善，转变为HFimpEF，但仍面临显著的临床风险。需要进一步研究以评估持续坚持GDMT和治疗优化对HFimpEF患者预后的影响。
