Heart Failure Improvement, Remission, and Recovery: A <i>European Journal of Heart Failure</i> Expert Consensus Document

Heart failure (HF) is a heterogeneous and dynamic syndrome characterized by progressive pathophysiological alterations, variable clinical trajectories, and differential responses to therapeutic interventions. The concept of HF with improved ejection fraction (HFimpEF) underscores this complexity, identifying patients who exhibit an increase in left ventricular ejection fraction (LVEF) following time and/or pharmacological and device-based therapies. However, the distinction between improvement, remission, and recovery remains inconsistently defined and is primarily LVEF-centric, lacking comprehensive assessment of structural, functional, and symptomatic HF status. This expert consensus document delineates HF trajectories, examines factors reflecting HF improvement beyond recovery of LVEF, and explores the prognostic implications of these phenotypic transitions. Emphasis is placed on the necessity of continued guideline-directed medical and device therapy to minimize the risk of relapse. While a subset of patients attains sustained myocardial and clinical recovery, others remain susceptible to relapse, necessitating individualized monitoring and long-term management. Persistent knowledge gaps regarding the safety and feasibility of treatment de-escalation, the role of genetic predisposition, and optimal therapeutic strategies underscore the need for further research to refine risk stratification and evidence-based decision-making in HFimpEF.

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Publication Details

Journal
European Journal of Heart Failure
Published
2025-06-18
DOI
https://doi.org/10.1002/ejhf.3732
Citations
9
Primary Topic
Heart Failure Treatment and Management
Type
article
Field-Weighted Citation Impact
12.49
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article

Heart Failure Improvement, Remission, and Recovery: A European Journal of Heart Failure Expert Consensus Document

Gianluigi Savarese, Antoni Bayes-genis A, L W Stevenson, Brian P. Halliday et al.
9 citations
European Journal of Heart Failure
Heart Failure Treatment and Management
12.49
article

Heart Failure Improvement, Remission, and Recovery: A European Journal of Heart Failure Expert Consensus Document

Gianluigi Savarese, Antoni Bayes-genis A, L W Stevenson, Brian P. Halliday, Marco Metra, Brenda Moura, Jean‐Sébastien Hulot, Wilfried Müllens, Jozine M. ter Maaten, Michele Senni, Mark C Petrie, Sophie Van Linhout
article en
9 citations

Abstract

Heart failure (HF) is a heterogeneous and dynamic syndrome characterized by progressive pathophysiological alterations, variable clinical trajectories, and differential responses to therapeutic interventions. The concept of HF with improved ejection fraction (HFimpEF) underscores this complexity, identifying patients who exhibit an increase in left ventricular ejection fraction (LVEF) following time and/or pharmacological and device-based therapies. However, the distinction between improvement, remission, and recovery remains inconsistently defined and is primarily LVEF-centric, lacking comprehensive assessment of structural, functional, and symptomatic HF status. This expert consensus document delineates HF trajectories, examines factors reflecting HF improvement beyond recovery of LVEF, and explores the prognostic implications of these phenotypic transitions. Emphasis is placed on the necessity of continued guideline-directed medical and device therapy to minimize the risk of relapse. While a subset of patients attains sustained myocardial and clinical recovery, others remain susceptible to relapse, necessitating individualized monitoring and long-term management. Persistent knowledge gaps regarding the safety and feasibility of treatment de-escalation, the role of genetic predisposition, and optimal therapeutic strategies underscore the need for further research to refine risk stratification and evidence-based decision-making in HFimpEF.

European Journal of Heart FailureVol. 27(10)
University Medical Center Groningen (NL), Inserm (FR), University of Groningen (NL), Universidade do Porto (PT), Guy's and St Thomas' NHS Foundation Trust (GB), Université Paris Cité (FR), Royal Brompton & Harefield NHS Foundation Trust (GB), Glasgow Royal Infirmary (GB), Harefield Hospital (GB), Karolinska Institutet (SE), Stockholm South General Hospital (SE), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Européen Georges-Pompidou (FR), Surgical Specialties (Canada) (CA), Ospedale Papa Giovanni XXIII (IT), Hôpital Européen (FR), CUF Porto Hospital (PT), Armed Forces Hospital (SA), German Centre for Cardiovascular Research (DE), Paris Cardiovascular Research Center (FR), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Ziekenhuis Oost-Limburg (BE), Hospital Universitari Germans Trias i Pujol (ES), French Clinical Research Infrastructure Network (FR), Imperial College London (GB), University of Glasgow (GB), University of Brescia (IT), Hasselt University (BE), Vanderbilt University Medical Center (US)
Good health and well-being
Openalex Percentile: Top 1%
Heart Failure Treatment and Management
12.49
DOIOpen Access PDFOpenAlex
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