The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis

Meta-Anal Global Grp Chronic Heart, MAGGIC Steering Grp, MAGGIC Coordinating Ctr, MAGGIC Stat Grp, MAGGIC Studies & Investigators, CHARM Investigators & Comm, C. Berry, R. N. Doughty, C. Granger, L. Kober, B. Massie, F. McAlister, J. McMurray, S. Pocock, K. Poppe, K. Swedberg, J. Somaratne, G. A. Whalley, A. Ahmed, B. AnderssonA. Bayes-Genis, C. Berry, M. Cowie, R. Cubbon, R. N. Doughty, J. Ezekowitz, J. Gonzalez-Juanatey, M. Gorini, I. Gotsman, L. Grigorian-Shamagian, M. Guazzi, M. Kearney, L. Kober, M. Komajda, A. di Lenarda, M. Lenzen, D. Lucci, S. Macin, B. Madsen, A. Maggioni, M. Martinez-Selles, F. McAlister, F. Oliva, K. Poppe, M. Rich, M. Richards, M. Senni, I. Squire, G. Taffet, L. Tarantini, C. Tribouilloy, R. Troughton, H. Tsutsui, G. A. Whalley, R. N. Doughty, J. Norrie

Research output: Contribution to journalArticlepeer-review

Abstract

A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF).

We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF epsilon 50. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28), and have a history of hypertension (51 vs. 41). Ischaemic aetiology was less common (43 vs. 59) in patients with HF-PEF. There were 121 [95 confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95 CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95 CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40.

Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.

Original languageEnglish
Pages (from-to)1750-1757
Number of pages8
JournalEuropean Heart Journal
Volume33
Issue number14
DOIs
Publication statusPublished - 6 Aug 2011

Keywords

  • Heart failure
  • Prognosis
  • Meta-analysis
  • SYSTOLIC FUNCTION
  • LONG-TERM
  • HOSPITALIZED-PATIENTS
  • NATRIURETIC PEPTIDE
  • ELDERLY-PATIENTS
  • CONTROLLED-TRIAL
  • MORTALITY
  • PROGNOSIS
  • DIAGNOSIS
  • DEATH

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