Aim: We aimed to describe the clinical course of patients with heart failure with reduced ejection fraction (HFrEF) after discharge from the heart failure clinics (HFC). Patients & methods: We reviewed the hospital's records of 610 patients that were discharged between 2013 and 2018 from the HFC at a single centre. Patients with no recurrent contact to ambulatory cardiac care were invited to an echocardiographic assessment. Results: Of the survivors, 72% were re-referred after discharge. Nearly 30% of the patients with no recurrent contact with ambulatory cardiac care had persistent HFrEF and further therapeutical optimizations were indicated in half of them. Conclusion: This highlights the importance to identify high-risk patients that would benefit from extended management in the HFC.

Background: We aimed to assess patients with heart failure with reduced ejection fraction (HFrEF) that were discharged from the heart failure clinic (HFC) after achieving guideline-directed medical therapy to understand their subsequent clinical course and to evaluate whether their treatment could be further optimized. Methods and results: Between 2013 and 2018, 610 HFrEF patients were discharged from the HFC at a single center in Copenhagen. Of the survivors (N=426), 326 (77%) were without advanced kidney, malignant or mental diseases, of which 234 (72 %) had been were re-referred in the interim period leaving 92 eligible patients with no recurrent contact with ambulatory cardiac care. These patients were invited to a clinical and echocardiographic assessment. Seventy-five patients agreed and were enrolled, of which 54 had improved LVEF > 40% (LVEF: 49 ± 6% at enrolment versus 28 ± 8% at diagnosis). Twenty-one patients with persistent HFrEF (LVEF: 34.0 ± 4.9% at enrolment versus 28 ± 7% at diagnosis) underwent a subsequent evaluation of their HF therapy. There was indication for further interventions in 48% of the patients with persistent HFrEF. The implemented interventions included initiation of angiotensin receptor-neprilysin inhibitors (N = 8) and sodium-glucose co-transporter 2 inhibitors (N = 4) and referral for implantation of prophylactic intracardiac defibrillator or cardiac resynchronization therapy (N = 5). Conclusions: Further guideline-directed medical therapy was indicated in half of the stable HFrEF patients discharged from the HFC. This highlights the importance of following up HFrEF patients despite initial fully optimized therapy.Funding Information: The study was supported by Novartis HealthCare A/S.Conflict of Interests: JA has received speaker fees from Novartis HealthCare A/S. AB has received speaker fees, consulting fees and travel support from Novartis HealthCare A/S.Ethical Approval: The study was approved by the Capital Region Committee on Health Research Ethics, Denmark (no. H-19030187), all patients gave written informed consent, and the study was performed according to the Helsinki Declaration II. Patient screening and data registration were carried out in accordance with the Danish Data Protection Legislation.