Patients whose heart function improves after being treated for heart failure may feel better, but stopping their medications could still put them at serious risk.
A new study from the Karolinska Institutet in Sweden has found that people who discontinue key heart failure drugs—even after recovering heart function—face a significantly higher chance of dying from heart-related causes or being hospitalized again.
The findings, published in the journal Circulation, underscore the importance of continuing treatment even when symptoms appear to have improved.
“Our study raises awareness about not withdrawing heart failure medications in everyday clinical practice,” said Gianluigi Savarese, senior author of the study and a cardiologist at Södersjukhuset Hospital in Stockholm.
What the Study Looked At
Researchers used data from the Swedish Heart Failure Registry (RiksSvikt) to examine over 8,700 patients who had been diagnosed with heart failure with reduced ejection fraction (a condition where the heart’s pump function is weakened, defined as an ejection fraction below 40%).
Over time, these patients improved and reached an ejection fraction of 40% or higher—a sign that heart function had partially or fully recovered.
However, researchers wanted to know what happened to patients who, after this improvement, stopped taking certain heart failure medications. They linked patient records to national health databases to track outcomes like hospitalizations and deaths over time.
What They Found
The study revealed a clear and concerning trend: patients who stopped taking any of three major classes of heart failure medications had 36–38% higher risk of heart-related death or hospitalization within just one year. These medications included:
- RASi (renin-angiotensin system inhibitors)
- ARNi (angiotensin receptor-neprilysin inhibitors)
- MRA (mineralocorticoid receptor antagonists)
However, the impact of stopping beta-blockers was more nuanced. Discontinuing beta-blockers only led to increased risk among patients whose heart function had improved only moderately. For those whose heart function had recovered more substantially, the risk increase from stopping beta-blockers was not statistically significant.
Why This Matters
Heart failure is a serious, chronic condition. While medication can help the heart recover and improve its function, this study suggests that the medications themselves may continue to protect the heart—even after improvement is seen. Stopping them too soon might reverse those gains or lead to new complications.
“This supports the current recommendation to continue with RASi/ARNi and MRA treatment long term,” said Dr. Savarese. “But it also opens up the conversation about whether beta-blockers might be tapered off in carefully selected patients who have fully recovered.”
What Comes Next?
Because this was an observational study, it cannot prove cause and effect. There’s a possibility that other factors—like additional health conditions or differences in care—may have influenced the outcomes. Still, the researchers believe their findings are strong enough to justify more research.
“Our goal is to understand exactly how these medications affect patients whose heart function improves and to determine if and when it’s safe to stop certain drugs,” said Christian Basile, the study’s first author and a Ph.D. student at Karolinska Institutet.
The team plans to conduct more studies that could lead to personalized treatment strategies, helping doctors decide which patients might safely reduce their medication load—and which should stay on full treatment indefinitely.
Final Thoughts
This study offers an important message for patients and doctors alike: feeling better doesn’t necessarily mean you’re fully recovered, especially with heart failure. Medications may continue to provide hidden protective benefits, even when symptoms disappear and heart function looks improved.
For now, experts recommend continuing all prescribed heart failure treatments unless advised otherwise by a healthcare provider. As research progresses, more tailored approaches may become available, but until then, staying on proven therapies remains the safest path forward.
If you care about heart health, please read studies that vitamin K helps cut heart disease risk by a third, and a year of exercise reversed worrisome heart failure.
For more health information, please see recent studies about supplements that could help prevent heart disease, stroke, and results showing this food ingredient may strongly increase heart disease death risk.
The research findings can be found in Circulation.
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