{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T02:44:48Z","timestamp":1792896288445,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"26","license":[{"start":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T00:00:00Z","timestamp":1556150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Alberta Health Services Chair in Cardiovascular Outcomes Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To identify variables predicting ejection fraction (EF) recovery and characterize prognosis of heart failure (HF) patients with EF recovery (HFrecEF).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Retrospective study of adults referred for \u22652 echocardiograms separated by \u22656\u2009months between 2008 and 2016 at the two largest echocardiography centres in Alberta who also had physician-assigned diagnosis of HF. Of 10\u00a0641 patients, 3124 had heart failure reduced ejection fraction (HFrEF) (EF\u2009\u2264\u200940%) at baseline: while mean EF declined from 30.2% on initial echocardiogram to 28.6% on the second echocardiogram in those patients with persistent HFrEF (defined by &amp;lt;10% improvement in EF), it improved from 26.1% to 46.4% in the 1174 patients (37.6%) with HFrecEF (defined by EF absolute improvement \u226510%). On multivariate analysis, female sex [adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.40\u20131.96], younger age (aOR per decade 1.16, 95% CI 1.09\u20131.23), atrial fibrillation (aOR 2.00, 95% CI 1.68\u20132.38), cancer (aOR 1.52, 95% CI 1.03\u20132.26), hypertension (aOR 1.38, 95% CI 1.18\u20131.62), lower baseline ejection fraction (aOR per 1% decrease 1.07 (1.06\u20131.08), and using hydralazine (aOR 1.69, 95% CI 1.19\u20132.40) were associated with EF improvements \u226510%. HFrecEF patients demonstrated lower rates per 1000 patient years of mortality (106 vs. 164, adjusted hazard ratio, aHR 0.70 [0.62\u20130.79]), all-cause hospitalizations (300 vs. 428, aHR 0.87 [0.79\u20130.95]), all-cause emergency room (ER) visits (569 vs. 799, aHR 0.88 [0.81\u20130.95]), and cardiac transplantation or left ventricular assist device implantation (2 vs. 10, aHR 0.21 [0.10\u20130.45]) compared to patients with persistent HFrEF. Females with HFrEF exhibited lower mortality risk (aHR 0.94 [0.88\u20130.99]) than males after adjusting for age, time between echocardiograms, clinical comorbidities, medications, and whether their EF improved or not during follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>HFrecEF patients tended to be younger, female, and were more likely to have hypertension, atrial fibrillation, or cancer. HFrecEF patients have a substantially better prognosis compared to those with persistent HFrEF, even after multivariable adjustment, and female patients exhibit lower mortality risk than men within each subgroup (HFrecEF and persistent HFrEF) even after multivariable adjustment.<\/jats:p>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehz233","type":"journal-article","created":{"date-parts":[[2019,4,2]],"date-time":"2019-04-02T19:37:57Z","timestamp":1554233877000},"page":"2110-2117","source":"Crossref","is-referenced-by-count":113,"title":["Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study"],"prefix":"10.1093","volume":"40","author":[{"given":"Anukul","family":"Ghimire","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nowell","family":"Fine","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin A","family":"Ezekowitz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Howlett","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Youngson","sequence":"additional","affiliation":[{"name":"Data Platform, Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finlay A","family":"McAlister","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"key":"2022102608532201700_ehz233-B1","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2022102608532201700_ehz233-B2","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1001\/jamacardio.2016.1325","article-title":"Characteristics and outcomes of adult outpatients with heart failure and improved or recovered ejection fraction","volume":"1","author":"Kalogeropoulos","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2022102608532201700_ehz233-B3","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1161\/CIRCULATIONAHA.113.006855","article-title":"Heart failure with recovered ejection fraction clinical description, biomarkers, and outcomes","volume":"129","author":"Basuray","year":"2014","journal-title":"Circulation"},{"key":"2022102608532201700_ehz233-B4","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.cardfail.2011.03.005","article-title":"Heart failure with recovered ejection fraction: a distinct clinical entity","volume":"17","author":"Punnoose","year":"2011","journal-title":"J Card Fail"},{"key":"2022102608532201700_ehz233-B5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ahj.2011.10.001","article-title":"Factors associated with improvement in ejection fraction in clinical practice among patients with heart failure: findings from IMPROVE HF","volume":"163","author":"Wilcox","year":"2012","journal-title":"Am Heart J"},{"key":"2022102608532201700_ehz233-B6","doi-asserted-by":"crossref","first-page":"e002826","DOI":"10.1161\/CIRCHEARTFAILURE.115.002826","article-title":"Heart failure and midrange ejection fraction: implications of recovered ejection fraction for exercise tolerance and outcomes","volume":"9","author":"Nadruz","year":"2016","journal-title":"Circ Heart Fail"},{"key":"2022102608532201700_ehz233-B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/CIRCHEARTFAILURE.116.003123","article-title":"Heart failure with improved ejection fraction: clinical characteristics, correlates of recovery, and survival","volume":"9","author":"Florea","year":"2016","journal-title":"Circ Heart Fail"},{"key":"2022102608532201700_ehz233-B8","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1161\/01.CIR.91.10.2573","article-title":"Effects of long-term enalapril therapy on cardiac structure and function in patients with left ventricular dysfunction. Results of the SOLVD echocardiography substudy","volume":"91","author":"Greenberg","year":"1995","journal-title":"Circulation"},{"key":"2022102608532201700_ehz233-B9","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/S0735-1097(97)00012-0","article-title":"Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-New Zealand Heart Failure Research Collaborative Group","volume":"29","author":"Doughty","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"2022102608532201700_ehz233-B10","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/S0735-1097(00)01006-8","article-title":"Antiremodeling effects on the left ventricle during beta-blockade with metoprolol in the treatment of chronic heart failure","volume":"36","author":"Groenning","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2022102608532201700_ehz233-B11","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.cardfail.2007.03.001","article-title":"Isosorbide dinitrate and hydralazine in a fixed-dose combination produces further regression of left ventricular remodeling in a well-treated black population with heart failure: results from A-HeFT","volume":"13","author":"Cohn","year":"2007","journal-title":"J Card Fail"},{"key":"2022102608532201700_ehz233-B12","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"2022102608532201700_ehz233-B13","doi-asserted-by":"crossref","first-page":"31.","DOI":"10.1186\/s12911-015-0155-5","article-title":"Methods for identifying 30 chronic conditions: application to administrative data","volume":"15","author":"Tonelli","year":"2015","journal-title":"BMC Med Inform Decis Mak"},{"key":"2022102608532201700_ehz233-B14","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.jchf.2015.12.011","article-title":"Variable contribution of heart failure to quality of life in ambulatory heart failure with reduced, better, or preserved ejection fraction","volume":"4","author":"Joyce","year":"2016","journal-title":"JACC Heart Fail"},{"key":"2022102608532201700_ehz233-B15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/CIRCHEARTFAILURE.116.003318","article-title":"Heart failure with a better ejection fraction","volume":"9","author":"Basuray","year":"2016","journal-title":"Circ Heart Fail"},{"key":"2022102608532201700_ehz233-B16","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cardfail.2017.09.005","article-title":"Heart failure with recovered ejection fraction in African Americans: results from the African-American Heart Failure Trial","volume":"24","author":"Chang","year":"2018","journal-title":"J Card Fail"},{"key":"2022102608532201700_ehz233-B17","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.ahj.2012.06.009","article-title":"The natural history of new-onset heart failure with a severely depressed left ventricular ejection fraction: implications for timing of implantable cardioverter-defibrillator implantation","volume":"164","author":"Teeter","year":"2012","journal-title":"Am Heart J"},{"key":"2022102608532201700_ehz233-B18","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.jacc.2018.05.042","article-title":"Dynamic trajectories of left ventricular ejection fraction in heart failure","volume":"72","author":"Lup\u00f3n","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2022102608532201700_ehz233-B19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/europace\/eut339","article-title":"Long-term outcome of \u201csuper-responder\u201d patients to cardiac resynchronization therapy","volume":"16","author":"Zecchin","year":"2014","journal-title":"Europace"},{"key":"2022102608532201700_ehz233-B20","doi-asserted-by":"crossref","first-page":"e001504","DOI":"10.1161\/JAHA.114.001504","article-title":"Persistent recovery of normal left ventricular function and dimension in idiopathic dilated cardiomyopathy during long-term follow-up: does real healing exist?","volume":"4","author":"Merlo","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2022102608532201700_ehz233-B21","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/j.jacc.2006.11.041","article-title":"Associations of gender and etiology with outcomes in heart failure with systolic dysfunction: a pooled analysis of 5 randomized control trials","volume":"49","author":"Frazier","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2022102608532201700_ehz233-B22","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1161\/01.CIR.88.1.107","article-title":"Survival after the onset of congestive heart failure in Framingham Heart Study subjects","volume":"88","author":"Ho","year":"1993","journal-title":"Circulation"},{"key":"2022102608532201700_ehz233-B23","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1161\/CIRCHEARTFAILURE.113.000813","article-title":"Long-term functional and clinical follow-up of patients with heart failure with recovered left ventricular ejection fraction after beta-blocker therapy","volume":"7","author":"de Groote","year":"2014","journal-title":"Circ Heart Fail"},{"key":"2022102608532201700_ehz233-B24","doi-asserted-by":"crossref","first-page":"844","DOI":"10.7326\/0003-4819-119-8-199310150-00011","article-title":"Discordance of databases designed for claims payment versus clinical information systems: implications for outcomes research","volume":"119","author":"Jollis","year":"1993","journal-title":"Ann Intern Med"},{"key":"2022102608532201700_ehz233-B25","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1161\/CIRCULATIONAHA.105.611194","article-title":"An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure","volume":"113","author":"Krumholz","year":"2006","journal-title":"Circulation"},{"key":"2022102608532201700_ehz233-B26","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1161\/CIRCOUTCOMES.110.954693","article-title":"Incremental value of clinical data beyond claims data in predicting 30-day outcomes after heart failure hospitalization","volume":"4","author":"Hammill","year":"2011","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2022102608532201700_ehz233-B27","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.jchf.2014.05.006","article-title":"Heart failure risk prediction models: what have we learned?","volume":"2","author":"Levy","year":"2014","journal-title":"JACC Heart Fail"},{"key":"2022102608532201700_ehz233-B28","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.jchf.2014.04.006","article-title":"Factors influencing the predictive powers of models for predicting mortality and\/or heart failure hospitalization in patients with heart failure","volume":"2","author":"Ouwerker","year":"2014","journal-title":"JACC Heart Fail"},{"key":"2022102608532201700_ehz233-B29","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.jchf.2014.04.008","article-title":"Risk prediction in patients with heart failure: a systematic review and analysis","volume":"2","author":"Rahimi","year":"2014","journal-title":"JACC Heart Fail"},{"key":"2022102608532201700_ehz233-B30","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/j.cjca.2017.05.009","article-title":"Heart failure in young adults is associated with high mortality: a contemporary population-level analysis","volume":"33","author":"Wong","year":"2017","journal-title":"Can J Cardiol"},{"key":"2022102608532201700_ehz233-B31","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/S0002-8703(03)00248-5","article-title":"Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods","volume":"146","author":"McGowan","year":"2003","journal-title":"Am Heart J"},{"key":"2022102608532201700_ehz233-B32","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0140-6736(18)32484-X","article-title":"Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial","volume":"393","author":"Halliday","year":"2019","journal-title":"Lancet"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/26\/2110\/46638974\/eurheartj_40_26_2110.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/26\/2110\/46638974\/eurheartj_40_26_2110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T08:58:04Z","timestamp":1666774684000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/40\/26\/2110\/5479867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,25]]},"references-count":32,"journal-issue":{"issue":"26","published-online":{"date-parts":[[2019,4,25]]},"published-print":{"date-parts":[[2019,7,7]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehz233","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,7,7]]},"published":{"date-parts":[[2019,4,25]]}}}