{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:52:07Z","timestamp":1782532327705,"version":"3.54.5"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":304,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The necessity of lifelong treatment and polypharmacy in chronic heart failure (HF) patients with improved myocardial function remains debated. This systematic review aims to synthesize current literature regarding this issue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A systematic literature search was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the inception to 18 October 2024. Seven studies (n\u2009=\u2009552) reporting minimization or withdrawal of pharmacotherapy in chronic HF patients with improved ejection fraction or stable New York Heart Association status were included. Findings were heterogeneous due to variations in study design and protocols. Loop diuretic withdrawal was favoured by one non-randomized study (n\u2009=\u200926) and one randomized controlled trial (RCT) (n\u2009=\u2009188). Minimization of angiotensin receptor\u2013neprilysin inhibitors (n\u2009=\u200977) or withdrawal of mineralocorticoid receptor antagonists (MRA) (n\u2009=\u200970) was not favourable. Carvedilol monotherapy was favoured by one small-sample RCT (n\u2009=\u200960). One RCT (n\u2009=\u200951) reported a high overall relapse rate (65%) following multiple drug withdrawal in recovered patients with dilated cardiomyopathy. Another RCT (n\u2009=\u200980) found a low occurrence of cardiac dimensional deterioration (7.5%) following multiple drug withdrawal in post-cardiac resynchronization therapy patients with normalized ejection fraction. However, 28% required drug re-initiation due to cardiac comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The existing evidence on minimizing or withdrawing oral pharmacotherapy in chronic HF patients with improved myocardial function remains very limited and heterogeneous, supporting only loop diuretic withdrawal and possibly carvedilol monotherapy, but not the minimization or withdrawal of renin\u2013angiotensin system inhibitors, MRA, or the combination of HF medications. Large RCTs are needed to determine the appropriate treatment strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3652","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T23:46:51Z","timestamp":1745192811000},"page":"2747-2759","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Minimization or Withdrawal of Oral Pharmacotherapy in Chronic Heart Failure Patients with Improved Myocardial Function: A Systematic Review"],"prefix":"10.1093","volume":"27","author":[{"given":"Yuxiang","family":"Luo","sequence":"first","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]},{"name":"Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University , Chongqing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbin","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Chongqing University Central Hospital , Chongqing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf Z.","family":"Sener","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter C.","family":"Meijers","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.A.","family":"van der Boon","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elfatih A.","family":"Hasabo","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences , Dublin ,","place":["Ireland"]},{"name":"Precision Cardiovascular Medicine & Innovation Institute (PCMI), Cardiovascular Research Institute (CVRI), Mater Private Network , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Soliman","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences , Dublin ,","place":["Ireland"]},{"name":"Precision Cardiovascular Medicine & Innovation Institute (PCMI), Cardiovascular Research Institute (CVRI), Mater Private Network , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf A.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7794-5991","authenticated-orcid":false,"given":"Kadir","family":"Caliskan","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"key":"2026021721515830100_ejhf3652-bib-0001","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators","year":"2018","journal-title":"Lancet"},{"key":"2026021721515830100_ejhf3652-bib-0002","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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