TY - JOUR
T1 - Long-term mortality in heart failure with mid-range ejection fraction
T2 - systematic review and meta-analysis
AU - Soundararajan, Deep
AU - Samarawickrema, Indira
AU - Das, Souvik
AU - Mehta, Abhinav
AU - Tuan, Lukah
AU - Jain, Sanjiv
AU - Dixit, Sanjay
AU - Marchlinski, Frank
AU - Abhayaratna, Walter P.
AU - Sanders, Prashanthan
AU - Pathak, Rajeev
N1 - Funding Information:
We acknowledge the support extended by Murray Turner, liaison librarian for Faculty of Health, Library, University of Canberra. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia.
Funding Information:
Dr Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate. Dr Sanders reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, and Boston Scientific. Dr Sanders reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, BD, and Microport. All other authors have no disclosures. Dr Pathak reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific and Biotronik. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, and Biotronik.
Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Funding Information:
We acknowledge the support extended by Murray Turner, liaison librarian for Faculty of Health, Library, University of Canberra. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia.
Funding Information:
We acknowledge the support extended by Murray Turner, liaison librarian for Faculty of Health, Library, University of Canberra. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia.
Funding Information:
Dr Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate. Dr Sanders reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, and Boston Scientific. Dr Sanders reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, BD, and Microport. All other authors have no disclosures. Dr Pathak reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific and Biotronik. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, and Biotronik.
Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/12
Y1 - 2022/12
N2 - AimsHeart failure patients with mid-range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta-analysis of studies reporting long-term outcomes in HFmrEF compared with HFrEF and HFpEF.Methods and resultsData from 18 eligible large-scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all-cause death than those with HFrEF [risk ratio (RR) = 0.92; 95% CI = 0.85–0.98; P < 0.001]. This significant difference was seen in the follow-up at 1, 2, and 3 years. Patients with HFmrEF had significantly lower risk of cardiovascular (CV) deaths than HFrEF (RR = 0.77; 95% CI = 0.65–0.92; P < 0.001). Subgroup analysis showed that studies recruiting >50% of males had higher risk of deaths with HFrEF (RR = 1.15; 95% CI = 1.04–1.26; P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all-cause death (RR = 1.02; 95% CI = 0.96–1.09; P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths; CV and non-CV deaths were insignificant between HFmrEF and HFpEF.ConclusionsThe results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107.
AB - AimsHeart failure patients with mid-range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta-analysis of studies reporting long-term outcomes in HFmrEF compared with HFrEF and HFpEF.Methods and resultsData from 18 eligible large-scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all-cause death than those with HFrEF [risk ratio (RR) = 0.92; 95% CI = 0.85–0.98; P < 0.001]. This significant difference was seen in the follow-up at 1, 2, and 3 years. Patients with HFmrEF had significantly lower risk of cardiovascular (CV) deaths than HFrEF (RR = 0.77; 95% CI = 0.65–0.92; P < 0.001). Subgroup analysis showed that studies recruiting >50% of males had higher risk of deaths with HFrEF (RR = 1.15; 95% CI = 1.04–1.26; P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all-cause death (RR = 1.02; 95% CI = 0.96–1.09; P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths; CV and non-CV deaths were insignificant between HFmrEF and HFpEF.ConclusionsThe results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107.
KW - Gender differences
KW - Heart failure
KW - Meta-analysis
KW - Mid-range ejection fraction
KW - Mortality
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85137236283&partnerID=8YFLogxK
U2 - 10.1002/ehf2.14125
DO - 10.1002/ehf2.14125
M3 - Article
SN - 2055-5822
VL - 9
SP - 4088
EP - 4099
JO - ESC Heart Failure
JF - ESC Heart Failure
IS - 6
ER -