Real-world improved, remission, and recovered heart failure: long-term follow-up outcomes

Heart failure (HF) is a complex and evolving clinical syndrome with diverse progression patterns and outcomes. Although left ventricular ejection fraction (LVEF) has long been used to classify HF and guide treatment, recent research indicates that an improvement in LVEF alone does not consistently mean true remission or recovery of HF.1 Many patients with improved LVEF continue to experience symptoms, abnormal biomarkers, or persistently high New York Heart Association (NYHA) class, highlighting the limitations of relying solely on LVEF.2–4 This has led to the need for a more nuanced and multidimensional approach to defining favourable HF trajectories—one that incorporates both clinical and molecular indicators. A recent European Journal of Heart Failure expert consensus document introduces a new classification framework, distinguishing improved-HF, HF-in-remission, and recovered-HF based upon LVEF, symptoms (NYHA class), N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, aetiology, and durability of the improvement.5 To better characterize HF trajectories and improve risk stratification, we retrospectively applied the recently proposed categories improved-HF, HF-in-remission, and recovered-HF—to a prospectively studied cohort of patients with HF and reduced LVEF. Using serial echocardiography, NYHA classification, and NT-proBNP measurements, we assessed the prognostic significance of these phenotypes, aiming to move beyond LVEF-based classification alone. We evaluated all consecutive ambulatory patients referred to a structured multidisciplinary HF clinic at a university hospital between May 2006 and December 2023. Eligibility criteria included a LVEF