Patient Characteristics Of Heart Failure With Improved Ejection Fraction (HFimpEF) Following Treatment With Sacubitril/Valsartan: A Real-world Experience From The Middle East

Abstract

Introduction With the contemporary role of sacubitril/valsartan (Sac-Val) in improving mortality, heart failure (HF) hospitalization, and positive remodeling, left ventricular recovery can be variable. There remains a need to understand patients who have been recently defined as heart failure with improved ejection fraction (HFimpEF). Aims In patients who have been treated with Sac-Val, we aim to describe patient characteristics in those who became HFimpEF vs. those who had persistent HFrEF in our newly established heart failure program in the Middle East-Gulf Region. Methods A total of 131 HFrEF (ejection fraction (EF) of ≤40%) patients were included in this study, who were started on Sac-Val, in addition to GDMT were followed up in our HF outpatient clinic between March 2016 to December 2019. We compared patients who had persistent HFrEF vs. those who became HFimpEF at 12 months follow-up, incorporating the latest universal definition of HFimpEF (symptomatic HF with a baseline EF ≤40% with a ≥ 10-point increase from baseline EF and a second measurement of LVEF > 40%). The comparison was made using appropriate testing methods, and a p-value <0.05 was considered statistically significant. Results After a follow-up of 12 months, 27.5% of patients became HFimpEF, while the others had persistent HFrEF (Table). Although there was no difference in baseline EF between the persistent HFrEF and HFimpEF group (27.2 ± 7.7 vs. 26.6 ± 7.8, p=0.6), patients in HFimpEF developed a significant higher EF at 12 months follow-up (48.6 ±7.2 vs. 28.7± 8.7, p<0.001). The proportions of patients with NYHA class ≥ 2 were comparable at baseline. However, patients in the HFimpEF group had a significantly lower proportion of patients with NYHA class ≥ 2 at follow-up (2.8% vs. 21%, p=0.01). Patients in the HFimpEF group were younger (50.9 ±15 vs. 59.2 ±14.3, p=0.004), tended to have lower baseline creatinine (0.86 ± 0.3 vs. 1 ± 0.4, p=0.08), and were less likely to be hypertensive (58.3% vs.79%, p=0.02), or Ischemic (25% vs. 63.2, p<0.001). Conclusion : Among patients who were treated with Sac-Val, the HFimpEF group had significantly higher EF and improved NYHA class at follow-up. Those who had persistent HFrEF were older with more cardiovascular co-morbidities. This analysis sheds light on future endeavors to better characterize HFimpEF patients. With the contemporary role of sacubitril/valsartan (Sac-Val) in improving mortality, heart failure (HF) hospitalization, and positive remodeling, left ventricular recovery can be variable. There remains a need to understand patients who have been recently defined as heart failure with improved ejection fraction (HFimpEF). In patients who have been treated with Sac-Val, we aim to describe patient characteristics in those who became HFimpEF vs. those who had persistent HFrEF in our newly established heart failure program in the Middle East-Gulf Region. A total of 131 HFrEF (ejection fraction (EF) of ≤40%) patients were included in this study, who were started on Sac-Val, in addition to GDMT were followed up in our HF outpatient clinic between March 2016 to December 2019. We compared patients who had persistent HFrEF vs. those who became HFimpEF at 12 months follow-up, incorporating the latest universal definition of HFimpEF (symptomatic HF with a baseline EF ≤40% with a ≥ 10-point increase from baseline EF and a second measurement of LVEF > 40%). The comparison was made using appropriate testing methods, and a p-value <0.05 was considered statistically significant. After a follow-up of 12 months, 27.5% of patients became HFimpEF, while the others had persistent HFrEF (Table). Although there was no difference in baseline EF between the persistent HFrEF and HFimpEF group (27.2 ± 7.7 vs. 26.6 ± 7.8, p=0.6), patients in HFimpEF developed a significant higher EF at 12 months follow-up (48.6 ±7.2 vs. 28.7± 8.7, p<0.001). The proportions of patients with NYHA class ≥ 2 were comparable at baseline. However, patients in the HFimpEF group had a significantly lower proportion of patients with NYHA class ≥ 2 at follow-up (2.8% vs. 21%, p=0.01). Patients in the HFimpEF group were younger (50.9 ±15 vs. 59.2 ±14.3, p=0.004), tended to have lower baseline creatinine (0.86 ± 0.3 vs. 1 ± 0.4, p=0.08), and were less likely to be hypertensive (58.3% vs.79%, p=0.02), or Ischemic (25% vs. 63.2, p<0.001). : Among patients who were treated with Sac-Val, the HFimpEF group had significantly higher EF and improved NYHA class at follow-up. Those who had persistent HFrEF were older with more cardiovascular co-morbidities. This analysis sheds light on future endeavors to better characterize HFimpEF patients.