APCU25OS19 Ejection fraction recovery in HFREF patients receiving SGLT2 inhibitors: real-world experience from a non-cardiac center in Malaysia

Introduction Heart failure (HF) is a syndrome of structural or functional cardiac abnormalities causing impaired output, classified by left ventricular ejection fraction (LVEF). In Asia are predominantly younger male comorbidities compared to Western populations. SGLT2 inhibitors have shown benefits across the EF spectrum. This study aimed to evaluate LVEF changes among HFrEF patients at Hospital Sultan Abdul Aziz Shah (HSAAS, UPM), with focus on SGLT2 inhibitor use, four-pillar therapy, and HF hospitalization history.Methods We retrospectively reviewed 163 patients seen at the HSAAS HF Clinic in 2024. Ninety-seven (56.5%) had HFrEF (EF 6 months (+9% absolute gain). In subgroup analyses, LVEF improved in patients on four-pillar therapy (34±9% to 43±15%, +9%), those with HF hospitalization (33±8% to 41±15%, +8%), and those without hospitalization (36±8% to 46±16%, +10%). Despite these numerical improvements, repeated measures ANOVA showed no statistically significant change in EF over time (p>0.05).Discussion Our findings demonstrate real-world EF recovery with modern HFrEF therapies, consistent with DAPA-HF and EMPEROR-Reduced where SGLT2 inhibitors improved outcomes across EF ranges. Hospitalized patients had least EF gains, reflecting both the adverse impact of decompensation and real-world barriers such as delayed echocardiography, treatment interruptions, and missing data, which may not reflect true recovery. Suboptimal ARNI and MRA uptake due to adverse effects further limits improvement. Optimizing therapy and adherence remain key strategies to enhance outcomes in this population.Conclusion In this non-cardiac center cohort, EF improved over time, especially in non-hospitalized patients. Optimizing GDMT uptake and preventing decompensation remain key to enhancing outcomes.