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GDMT Maintenance After LVEF Recovery — EECC MCQ

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EasyHeart FailureGDMT Maintenance After LVEF RecoveryEECC

A 65-year-old man with HFrEF on GDMT has his echocardiogram repeated. His LVEF is now 40% (improved from 25%). He remains in NYHA class II. Should his medications be adjusted?

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Correct answer: D — GDMT should be maintained at maximally tolerated doses even with LVEF improvement — the medications are maintaining the improved state, and withdrawal risks relapse; continue all four pillars and reassess device therapy indications

LVEF improvement on GDMT is encouraging but should NOT trigger dose reduction or drug withdrawal. The TRED-HF trial showed 44% relapse rate after GDMT withdrawal in recovered cardiomyopathy. The ESC 2023 HF Guidelines recommend: (1) continue ALL four pillars at maximally tolerated doses indefinitely; (2) reassess device therapy indications (ICD if LVEF was ≤35% may need revisiting at generator change if LVEF now >35%, but this is a nuanced decision); (3) CRT should continue if in situ; (4) regular follow-up to ensure sustained improvement. The concept of 'HF with recovered EF' (HFrecEF) is increasingly recognised as a distinct phenotype — these patients remain at risk of relapse and should be managed as HFrEF patients for medication purposes.

Reference: ESC (2023): HF Guidelines