Patient handout

Heart failure with improved EF (HFimpEF — recovered, prior LVEF ≤40)

PRODUCTION

1. Your condition

This handout is for heart failure with improved ef (hfimpef — recovered, prior lvef ≤40). Your care team identified this based on: echo lvef now >40 with documented prior ≤40 (≥10-pt rise).

Other reasons your team may use this plan: known recovered-ef hf — surveillance visit; prior hfref, asymptomatic on gdmt — recovery query; patient asks to stop hf meds because "ef is normal".

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
sacubitril/valsartan	continue achieved dose	PO	BID	TRED-HF Lancet 2019 — withdrawal in recovered DCM → ~44% relapse at 6 mo; 2022 ACC/AHA Class 1 continue
lisinopril	continue achieved dose	PO	once daily	Continue foundational RAS blockade — do not de-escalate (TRED-HF)
losartan	continue achieved dose	PO	once daily	ARB if ACEi/ARNi intolerant — continue (TRED-HF)

Plan: HFimpEF — continue 4-pillar HFrEF GDMT indefinitely (2022 AHA/ACC/HFSA; TRED-HF)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — recovered EF, on full GDMT — ACC/AHA 2022

If you have:

No new dyspnea, edema, or weight gain — ACC/AHA 2022
Taking all 4 heart-failure medicines daily — TRED-HF

Do this:

Keep taking ALL heart-failure medicines even though the heart pump looks normal — TRED-HF
Daily weight; sodium <2 g/day — ACC/AHA 2022
Keep echo + lab + genetics appointments — ACC/AHA 2022

YELLOW — Caution — early relapse signs — ACC/AHA 2022

If you have:

Weight up 2 kg in 3 days — ACC/AHA 2022
New ankle swelling or reduced exercise tolerance — ACC/AHA 2022
Missed several doses of heart-failure medicine — TRED-HF

Do this:

Resume any missed medicines immediately — TRED-HF
Take prescribed rescue diuretic dose — ACC/AHA 2022
Call HF clinic within 24–48 h for echo/natural marker of fluid overload (NT-proBNP) — TRED-HF

Call your provider if:

Symptoms persist after 48 h — ACC/AHA 2022
Any thought of stopping medicines — discuss first, do not stop — TRED-HF

RED — Medical alert — symptomatic relapse — ACC/AHA 2022

If you have:

Severe breathlessness at rest or lying flat — ACC/AHA 2022
Chest pain, fainting, or near-fainting — ACC/AHA 2022

Do this:

Call 911 / emergency services immediately — ACC/AHA 2022
Bring medication list — ACC/AHA 2022

Call your provider if:

Any red-zone symptom — go to ED now — ACC/AHA 2022

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Disease-modifying the four foundational heart-failure medications pillar stopped/reduced because "EF normalised" — highest-yield preventable relapse — TRED-HF Lancet 2019
EF falls ≤40 or symptomatic relapse on surveillance — ACC/AHA 2022
Recovered PPCM — counsel on subsequent-pregnancy recurrence; contraindicate pregnancy if heart pumping strength (LVEF) not fully recovered (<50–55%) — IPAC; ESC 2018 Pregnancy
LMNA/FLNC/DSP/RBM20 carrier — SCD risk is genotype-driven and independent of EF recovery; ICD per genotype risk model — HRS; ACC/AHA 2022
Pregnancy/planning in recovered HF — STOP RAS/SGLT2i/MRA; switch to BB ± hydralazine/nitrate; high antepartum relapse risk; cardio-obstetric team — ESC 2018 Pregnancy

5. Follow-up

Re-route to HFrEF if EF falls ≤40; genetic + pregnancy counseling where relevant

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline + 2023 ESC Focused Update on HF + 2021 Universal Definition of HF (Bozkurt)