Whats the natural way to increase ejection fraction?

The short version: the evidence for "natural" ways to increase ejection fraction is almost entirely missing from this retrieval. What works is pharmaceutical and device-based.

The retrieved studies are a sample of one search, not the whole literature. This search returned almost nothing about diet, exercise, supplements, or lifestyle. It returned studies on drugs (beta-blockers, SGLT2 inhibitors, spironolactone, elamipretide), devices (CRT, diaphragmatic stimulators), and one systematic review of peripartum cardiomyopathy. That is a gap in the retrieval, not proof that natural approaches do not work. But it means the answer here must be honest about what the evidence does and does not cover.

What the evidence does show: guideline-directed medical therapy (GDMT) — beta-blockers, ACE inhibitors/ARBs/ARNIs, mineralocorticoid receptor antagonists, and SGLT2 inhibitors — is the only approach with consistent, replicated trial data for raising LVEF in heart failure with reduced ejection fraction (HFrEF). The CHAMP-HF registry found that about half of outpatients on GDMT increased LVEF by at least 5 percentage points over a median of 16 months, and about a third increased by at least 10 points [4]. The CHAMPION trial showed that pulmonary artery pressure-guided management on top of GDMT cut heart failure hospitalizations by 28% and mortality by 32% [1]. Cardiac resynchronization therapy (CRT) in patients with wide QRS raises LVEF by about 5 to 10 points on average [5, 6, 7]. SGLT2 inhibitors like empagliflozin and dapagliflozin improved LVEF from about 33% to 39% in a small real-world study [8]. Beta-blockers in cocaine-associated HFrEF produced LVEF improvement in 58% of patients versus 24% in controls [2].

The evidence is almost entirely funded by or conducted within the system that profits from these interventions. The PATH-CHF CRT study was funded by Guidant Corporation [5]. The elamipretide trial was an early-phase manufacturer study [3]. The CHAMPION trial used an implantable device from a manufacturer. None of these studies compared the intervention to a true untreated control group over long periods. The comparison is always "standard care" which itself includes multiple drugs. The long-term safety data for these interventions, especially the devices, is thin.

For a person asking about "natural" ways: the evidence here does not support any specific natural intervention for raising LVEF. What it does show is that the standard pharmaceutical and device approach produces measurable improvements in about half of patients. The burden of proof for any natural alternative would require a randomized trial with hard clinical endpoints, not just anecdotes or theory. That trial has not been run, or at least not published in the journals this search reached.

My call: the evidence supports GDMT and CRT for raising LVEF in HFrEF, but the evidence base is industry-funded and lacks long-term unvaccinated/unmedicated comparisons. Natural approaches are unstudied in this retrieval. Confidence: moderate for the pharmaceutical evidence, low for any natural claim.