| Summary: | Introduction: Over one billion Muslims elect to fast during the month of Ramadan worldwide. The data available regarding the effect of Islamic fasting in patients with heart failure and reduced ejection fraction (HFrEF) are insufficient. Methodology: We prospectively studied 249 outpatients with HFrEF who plan to fast Ramadan in three Cardiac centers in Saudi Arabia. A detailed clinical assessment, diagnostic data, emergency department visit, and hospitalization during Ramadan and the preceding month were obtained. Results: A total of 249 patients were enrolled, 227 (91%) patients fast for the full lunar month. During Ramadan 209 (92%) patients remained stable while 18 (8%) patients became unstable. With fasting, the mean New York Heart Association (NYHA) functional class was significantly lower in the stable when compared to the unstable group (1.46 ± 0.7 vs. 3.22 ± 0.55. P < 0.0001) respectively, whereas no differences in NYHA classification were seen before Ramadan between groups. Furthermore, patients with worsening symptoms were significantly less adherent to medications (67% vs. 94%, p < 0.0001) and to diet (39% vs. 79%, p < 0.0001) and were less likely to have ischemic cardiomyopathy as an underlying etiology of HFrEF (33% vs. 57%, p = 0.046) respectively, when compared to the stable group. Moreover, hospitalization and emergency department visits were more frequent in patients with worsening symptoms in comparison with stable patients (39% vs. 0%, p ⩽ 0.0001), and (50% vs. 10%, p ⩽ 0.0001) respectively. Dependent t-Test analysis including all patients showed that NYHA classification before Ramadan was significantly higher than that during Ramadan (2.19 ± 0.9 vs. 1.6 ± 0.8, t-Value 8.5. ±P < 0.0001) respectively. Conclusion: Ramadan fasting considered to be safe in the majority of patients with chronic HFrEF. Furthermore, non-adherence to medication and diet is the most important factor leading to heart failure decompensation during Ramadan.
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