{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:39:20Z","timestamp":1792618760081,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Heart failure with improved ejection fraction (EF) is increasingly recognized as a sizable and distinct entity. While the features associated with improvedEF have been explored and new guidelines have emerged, factors associated with sustaining an improved EF over time have not been defined. We aimed to assess factors associated with maintenance of an improved EF in a large real\u2010world patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">A total of 7070 participants with heart failure with improved EF and a subsequent echocardiogram performed after at least 9\u2009months of follow\u2010up were included in a retrospective cohort study conducted at the Cleveland Clinic in Cleveland, Ohio. Multiple logistic regression models, adjusted for demographics, comorbidities, and medications were built to identify characteristics and therapeutic interventions associated with maintaining an improved EF. Mean age (SD) was 64.9 (13.8) years, 62.7% were men, and 75.1% were White participants. White race and the use of angiotensin\u2010converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor\u2013neprilysin inhibitors were associated with maintaining the EF at least 9\u2009months after EF improvement. In contrast, male sex or having atrial fibrillation\/flutter, coronary artery disease, history of myocardial infarction, presence of an implanted cardioverter\u2010defibrillator, and use of loop diuretics were associated with a decline in EF after previously documented improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Continued use of renin\u2013angiotensin\u2013aldosterone system inhibitors was associated with maintaining the EF beyond the initial improvement phase.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.031093","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T10:08:27Z","timestamp":1698401307000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Factors Associated With Maintenance of an Improved Ejection Fraction: An Echocardiogram\u2010Based Registry Study"],"prefix":"10.1161","volume":"12","author":[{"given":"Brenna","family":"McElderry","sequence":"first","affiliation":[{"name":"Department of Medicine Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, School of Medicine Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6831-8611","authenticated-orcid":false,"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH USA"},{"name":"Cleveland Clinic Lerner College of Medicine Cleveland OH 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