What is the treatment approach for HF with improved EF (HFimpEF)?

What is the treatment approach for HF with improved EF (HFimpEF)?

• A. Discontinue HFrEF management
• B. Continue HFrEF management
• C. Switch to HFpEF protocol
• D. Consider inotrope therapy only

Answer: (B)

HF with improved EF means the heart’s pumping function has gotten better with therapy, but the underlying disease process can still be present and relapse is possible if treatment is stopped. The best approach is to continue guideline-directed medical therapy for HFrEF, not to discontinue it just because EF has improved. These therapies—such as ACE inhibitors or ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors—target the neurohormonal and remodeling processes that drive heart failure, and continuing them reduces death and hospitalization even after EF rises. If the patient tolerates them, maintain or even up-titrate to recommended doses, and monitor kidney function, electrolytes, and blood pressure. Switching to a HFpEF protocol isn’t appropriate based solely on EF improvement, since HFpEF management differs and EF recovery doesn’t automatically convert the patient’s phenotype. Inotropic therapy alone is not a long-term strategy for HFimpEF and is reserved for specific acute situations.

HF with improved EF means the heart’s pumping function has gotten better with therapy, but the underlying disease process can still be present and relapse is possible if treatment is stopped. The best approach is to continue guideline-directed medical therapy for HFrEF, not to discontinue it just because EF has improved. These therapies—such as ACE inhibitors or ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors—target the neurohormonal and remodeling processes that drive heart failure, and continuing them reduces death and hospitalization even after EF rises. If the patient tolerates them, maintain or even up-titrate to recommended doses, and monitor kidney function, electrolytes, and blood pressure. Switching to a HFpEF protocol isn’t appropriate based solely on EF improvement, since HFpEF management differs and EF recovery doesn’t automatically convert the patient’s phenotype. Inotropic therapy alone is not a long-term strategy for HFimpEF and is reserved for specific acute situations.