Heart Failure With Improved Ejection Fraction (HFimpEF): Current Evidence, Clinical Implications, and Future Directions

Abstract

Heart failure with improved ejection fraction (HFimpEF) has emerged in recent years as a distinct clinical phenotype within the spectrum of heart failure subtypes. Current evidence supports the hypothesis that HFimpEF represents a state of functional remission rather than a definitive cure, with important clinical implications, particularly for the continuation of guideline-directed medical therapy (GDMT) and for decision-making regarding device therapies. Withdrawal or de-escalation of treatment is associated with high rates of recurrent systolic function deterioration, justifying the indefinite continuation of disease-modifying therapy. A descriptive narrative review of the available literature was performed to summarise current evidence on the definition, epidemiology, pathophysiological mechanisms, left ventricular ejection fraction (LVEF) trajectories, advanced diagnostic tools, and therapeutic considerations in HFimpEF, and to discuss the main knowledge gaps and future research directions. A better understanding of this phenotype will enable more effective risk stratification and progress towards more individualised management of patients with heart failure, with potential benefits for long-term patient outcomes and care.