When to implant an ICD in patients with heart failure and reduced ejection fraction? Insights from the HF-OPT trial

Abstract

Abstract Background In patients with de novo heart failure with reduced ejection fraction (HFrEF) improvement of left ventricular ejection fraction (LVEF) is expected to occur when started on guideline-recommended medical therapy (GRMT). However, the period of time, when LVEF improvement is completed, is unknown. Purpose Evaluation of improvement of LVEF >35% within the first year after de novo diagnosis of HFrEF with severely reduced LVEF <35%. Methods In the prospective HF-OPT-trial, patients with de novo HFrEF and LVEF ≤35% prescribed the wearable cardioverter defibrillator (WCD) were enrolled and followed up to one year. GRMT was initiated and uptitrated according current guidelines. LVEF improvement >35% under GRMT was echocardiographically assessed at day 0, day 90, day 180 and day 360. Results A total of 487 patients (59 years (IQR: 51-68), 27% women) were followed until day 180. Out of 487 patients 392 patients were followed additionally to day 360. Dosages of GRMT were significantly increased during follow-up (p<0.001) At 90 days, 46% (CI: 41%-50%) of the patients had LVEF improvement >35%. About half of those with persistently LVEF<35% at day 90 (46%, CI: 40%-52%) had LVEF improvement >35% by day 180, increasing the total rate of improvement >35% to 68% (CI: 63% - 72%). Until day 360 the rate of LVEF improvement >35% increased to 78%. Conclusions 78% of patients with de novo HFrEF showed improvement in LVEF >35% during the first year after diagnosis following GRMT. This finding impacts decision making for primary preventive ICD implantation.Development of LVEF.