Beta-blOckers discoNtinuation in Patients Presenting Heart FaIlure With REcovered Left Ventricular Ejection Fraction

Prior treatment

• Severe valvulopathy, restrictive, infiltrative or hypertrophic cardiomyopathy, constrictive pericarditis, or acute myocarditis within 3 months prior to inclusion Visit.
• Any past solid organ transplantation or planned organ transplantation within 12 months

Other illness

• Atrial, supra-ventricular, or ventricular arrhythmias, in the last 12 months and/or requiring beta-blockers according to investigator.
• Uncontrolled arterial hypertension according to investigator decision.
• Symptomatic angina or evidence of infra-clinic myocardial ischemia requiring beta-blockers according to investigator decision.
• Cardiac resynchronization therapy
• Extra-cardiac conditions requiring beta-blockers (migraine, essential tremor, prevention of bleeding from esophageal varices in patients with liver cirrhosis, adrenergic symptoms of hyperthyroidism…) according to investigator decision.
• History of severe outcomes at beta-blockers interruption: HF relapse, occurrence of arrythmias
• Hepatic insufficiency classified as Child-Pugh B or C at the inclusion Visit.
• Any condition other than HF that could limit survival to less than one year
• Any disorder, unwillingness or inability, which in investigator's opinion, might jeopardise the patient's safety or compliance with the protocol

Lab values

• Chronic renal failure with eGFR \<20mL/Min per 1.73m² (CKD-Epi) at inclusion

Other

• Planned coronary, carotid, or peripheral artery revascularization known at the day of inclusion
• Pregnancy or breastfeeding women or women of childbearing potential without adequate contraceptive method
• Current participation in another interventional trial.
• Patient under legal protection (protection of the court, or in curatorship or guardianship).

• Age ≥ 18 years-old
• Established diagnosis of HF for more than 12 months, from an ischemic or a non-ischemic origin
• With a documented history of reduced left ventricular ejection fraction (LVEF ≤ 45%), followed by a normalisation of LVEF (≥ 50 % for the last 6 months) assessed by cardiac echography.
• With a left ventricular end diastolic volume indexed to body surface area (LVEDVi) within the normal range (≤74ml/m2 in men and ≤61 ml/m2 in women)
• No or mild symptoms of HF (defined as NYHA functional class I or II)
• No heart failure-related hospital admission within the last six months
• Currently receiving a beta-blocker indicated for chronic heart failure (i.e. bisoprolol or carvedilol or metoprolol or nebivolol) whatever the dose used, for at least 12 months
• And receiving the guideline-directed optimal medical therapy for at least 12 months (i.e., maximal tolerated dose of SGLT2 inhibitors, and of RAAS blocker (Angiotensin receptor neprilysin inhibitor OR Angiotensin-converting-enzyme-inhibitors OR Angiotensin II receptors blockers), and MRA if tolerated). Loop diuretics use is adjusted to congestive signs according to physicians' decision.
  • No initiation or major adjustment in heart failure therapies should have occurred during the 3 months prior to study inclusion.
• With or without ICD
• Ability to provide written informed consent to participate to the study
• Patient affiliated to Social Security