The association of improvement in left ventricular ejection fraction with outcomes in patients with heart failure with reduced ejection fraction: data from <scp>CHAMP‐HF</scp>
Adam D. DeVore, Anne S. Hellkamp, Laine Thomas, Nancy M. Albert, Javed Butler, J. Herbert Patterson, John A. Spertus, Fredonia B. Williams, Xian Shen, Adrian F. Hernandez, Gregg C. Fonarow
Abstract
AIMS: We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. METHODS AND RESULTS: CHAMP-HF was a registry of outpatients with heart failure (HF) and LVEF ≤40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (≥10%) over time and concurrent changes in KCCQ-12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th-75th percentile 58-75), 29% female, median duration of HF 2.7 years (0.6-6.8), and median baseline LVEF 30% (23-35). Of the study participants, 689 (33%) had a ≥10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ-12 overall summary score compared with participants without an LVEF improvement (+7.6 vs. +3.5, adjusted effect estimate +4.01 [95% confidence interval CI 2.3-5.7]). Similarly, subsequent all-cause death or HF hospitalization occurred in 12% in the LVEF improvement group versus 25% in the group without an LVEF improvement (adjusted hazard ratio 0.50, 95% confidence interval 0.41-0.61). CONCLUSION: In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF.