TRED-HF Recovery Relapse Prediction Model
- TRED-HF Recovery / Relapse Prediction — explanation and clinical context
The TRED-HF randomized pilot trial examined phased withdrawal of all heart failure pharmacotherapy in carefully selected patients with previously dilated cardiomyopathy who had asymptomatic recovery of left ventricular function (LVEF ≥50%), normalised indexed LV volumes, and low NT-proBNP at baseline; approximately 40–44% of participants relapsed within months after withdrawal, showing that recovery is often remission rather than permanent cure.
Analyses derived from the TRED-HF dataset have repeatedly highlighted baseline NT-proBNP and rises in heart rate after withdrawal as important harbingers of relapse; higher baseline NT-proBNP and early increases in heart rate during medication reduction were associated with greater relapse risk. Other features suggested as informative include residual LV dilation (indexed LVEDV), and the extent/intensity of background disease-modifying therapy—likely reflecting underlying disease severity. Because the original TRED-HF publication did not provide an externally validated point-by-point risk equation for bedside use, this calculator implements an explicit, transparent, approximate logistic estimator based on those reported predictors for educational demonstration only.
Clinical interpretation summary: A higher estimated probability in this model reflects a higher likelihood that withdrawal of therapy would be followed by objective relapse (reduction in LVEF, increase in LV volume, rise in NT-proBNP or clinical HF). Given the limited sample size of TRED-HF, the heterogeneity of recovered DCM, and changes in contemporary therapy (ARNi, SGLT2i widely used after TRED-HF), any numeric estimate should be interpreted cautiously—this tool is not a substitute for individualized clinical judgement, imaging, and biomarkers in shared decision-making.
References:
Halliday BP, Wassall R, Lota AS, Khalique Z, Gregson J, Newsome S, et al. Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. Lancet. 2019;393(10166):61–73. doi:10.1016/S0140-6736(18)32484-X.
Cheng L, et al. Long-term follow-up of the TRED-HF trial. (analysis / follow-up reporting relapse and predictors). Eur J Heart Fail / PubMed Central (2024–2025).
Halliday BP, Owen R, Gregson J, et al. Heart rate as a marker of relapse during withdrawal of therapy in recovered dilated cardiomyopathy. JACC Heart Fail. 2021;9:509–517. doi:10.1016/j.jchf.2021.03.010.
Additional context and review of HF recovery/remission literature: review articles and guideline discussions summarizing implications of TRED-HF.
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