Characteristics and outcomes of HFpEF with declining ejection fraction

Jin Joo Park, Chan Soon Park, Alexandre Mebazaa, Il Young Oh, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticle

5 Scopus citations


Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: identifier: NCT01389843. URL:

Original languageEnglish
Pages (from-to)225-234
Number of pages10
JournalClinical Research in Cardiology
Issue number2
StatePublished - 1 Feb 2020


  • Heart failure with declining ejection fraction
  • Mortality
  • Predictor
  • Prognosis
  • Treatment

Fingerprint Dive into the research topics of 'Characteristics and outcomes of HFpEF with declining ejection fraction'. Together they form a unique fingerprint.

  • Cite this

    Park, J. J., Park, C. S., Mebazaa, A., Oh, I. Y., Park, H. A., Cho, H. J., Lee, H. Y., Kim, K. H., Yoo, B. S., Kang, S. M., Baek, S. H., Jeon, E. S., Kim, J. J., Cho, M. C., Chae, S. C., Oh, B. H., & Choi, D. J. (2020). Characteristics and outcomes of HFpEF with declining ejection fraction. Clinical Research in Cardiology, 109(2), 225-234.