Heart failure improvement, remission, and recovery: A European Journal of Heart Failure expert consensus document

Abstract

Heart failure (HF) is a heterogeneous and dynamic syndrome characterized by progressive pathophysiological alterations, variable clinical trajectories, and differential responses to therapeutic interventions. The concept of HF with improved ejection fraction (HFimpEF) underscores this complexity, identifying patients who exhibit an increase in left ventricular ejection fraction (LVEF) following time and/or pharmacological and device-based therapies. However, the distinction between improvement, remission, and recovery remains inconsistently defined and is primarily LVEF-centric, lacking comprehensive assessment of structural, functional, and symptomatic HF status. This expert consensus document delineates HF trajectories, examines factors reflecting HF improvement beyond recovery of LVEF, and explores the prognostic implications of these phenotypic transitions. Emphasis is placed on the necessity of continued guideline-directed medical and device therapy to minimize the risk of relapse. While a subset of patients attains sustained myocardial and clinical recovery, others remain susceptible to relapse, necessitating individualized monitoring and long-term management. Persistent knowledge gaps regarding the safety and feasibility of treatment de-escalation, the role of genetic predisposition, and optimal therapeutic strategies underscore the need for further research to refine risk stratification and evidence-based decision-making in HFimpEF.