Characteristics and outcomes of HFpEF with declining ejection fraction

Jin Joo Park, Chan Soon Park, Alexandre Mebazaa, Il Young Oh, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: identifier: NCT01389843. URL:

Original languageEnglish
Pages (from-to)225-234
Number of pages10
JournalClinical Research in Cardiology
Issue number2
Publication statusPublished - 2020 Feb 1

Bibliographical note

Funding Information:
The Korean Acute Heart Failure Registry study was conducted in ten tertiary medical centers: Seoul National University Hospital, Seoul, Korea; Sungkyunkwan University College of Medicine, Seoul, Korea; University of Ulsan College of Medicine, Seoul, Korea; Chungbuk National University College of Medicine, Cheongju, Korea; Kyungpook National University College of Medicine, Daegu, Korea; the Catholic University of Korea, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Yonsei University Wonju College of Medicine, Wonju, Korea; Seoul National University Bundang Hospital, Seongnam, Korea; and Heart Research Center of Chonnam National University, Gwangju, Korea.

Funding Information:
This work was supported by Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and by the SNUBH Research Fund (Grant nos. 14-2015-029, 16-2017-003).

Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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