TOPLINE:

Early and intensive optimisation of guideline-directed medical therapy (GDMT) resulted in the recovery of left ventricular ejection fraction (LVEF) in 58% of patients with heart failure with reduced ejection fraction (HFrEF) and LVEF ≤ 35% within the first 3 months of diagnosis.

METHODOLOGY:

• In this prospective cohort study, researchers investigated LVEF recovery with the rapid and intensive use of GDMT in patients with HFrEF and LVEF ≤ 35%.
• They included 106 patients newly diagnosed with HFrEF and baseline LVEF ≤ 35% (mean age, 63 years; 25% women) between 2019 and 2022 at a Portuguese hospital.
• Patients participated in a programme that rapidly initiated and uptitrated GDMT, reaching optimised medical therapy in about 6 weeks with visits every 2 weeks.
• The primary endpoint was the proportion of patients whose LVEF rose above 35% from baseline to 3 months and from 3 to 12 months, assessed using echocardiography.

TAKEAWAY:

• At 3 months, the mean LVEF increased from 27% to 37% (P < .001), with 58% of patients achieving LVEF above 35%.
• Among patients who achieved LVEF above 35% at 3 months, the median LVEF increased from 43% to 45% at 12 months.
• Among patients with LVEF ≤ 35% at 3 months, only 18% recovered by 12 months, and most of them had received cardiac resynchronisation therapy.
• Two deaths, four hospitalisations due to HF, and 37 implantable cardioverter-defibrillator implants were recorded during follow-up.

IN PRACTICE:

"Patients who did not reach this threshold [> 35%] by 3 months showed limited further recovery, indicating that this time point may be useful for guiding decisions regarding ICD [implantable cardioverter-defibrillator] implantation," the researchers wrote.

SOURCE:

This study was led by Diogo Rosa Ferreira, Universidade de Lisboa, Lisbon, Portugal. It was published online on November 09, 2025, in ESC Heart Failure.

LIMITATIONS:

This observational study may have been subject to biases related to patient selection, outcome measurement, and missing data. The study was conducted at a single centre, thus potentially limiting generalisability. Subgroup analyses depending on key arrhythmic risk markers were not performed.

DISCLOSURES:

This study received funding from the Fundação para a Ciência e Tecnologia through a grant - Centro Cardiovascular da Universidade de Lisboa. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.